Meta-analysis of fourteen studies confirms elevated Lp(a) raises MACE, mortality, MI and revascularisation risk in ischaemic heart disease (Cureus 2024)

Lipoprotein(a) (Lp(a)) has emerged as a significant cardiovascular risk factor, particularly in patients with ischemic heart disease (IHD). This systematic review and meta-analysis aimed to synthesize evidence on the impact of Lp(a) levels on cardiovascular outcomes in IHD patients. A comprehensive literature search was conducted across multiple databases, covering publications from January 2016 to October 2024. Studies assessing the relationship between Lp(a) levels and cardiovascular outcomes in IHD patients were included. The primary outcomes were major adverse cardiovascular events (MACE), all-cause mortality, myocardial infarction, and revascularization. Quality assessment was performed using the Newcastle-Ottawa Scale. Fourteen studies (five prospective, nine retrospective) met the inclusion criteria, with sample sizes ranging from 350 to 18,544 participants. Pooled analysis revealed that elevated Lp(a) levels were significantly associated with increased risk of MACE (HR: 1.31, 95% CI: 1.19-1.45), all-cause mortality (HR: 1.23, 95% CI: 1.15-1.31), myocardial infarction (HR: 1.20, 95% CI: 1.06-1.35), and revascularization (HR: 1.23, 95% CI: 1.08-1.39) in IHD patients. Sensitivity analyses confirmed the robustness of these findings. This meta-analysis provides strong evidence that elevated Lp(a) levels are associated with adverse cardiovascular outcomes in IHD patients. The findings underscore the potential role of Lp(a) as an important prognostic marker and suggest that incorporating Lp(a) assessment into clinical practice could enhance risk stratification. Future research should focus on establishing optimal Lp(a) cutoff values and evaluating the impact of Lp(a)-lowering therapies on cardiovascular outcomes in this high-risk population.