Elevated Lp(a) predicts periprocedural stroke and later ACS after carotid endarterectomy but not restenosis, systematic review of 1,450 patients finds (J Clin Med 2025)

Background/Objectives: Numerous studies have highlighted lipoprotein (a) (Lp(a)) as a significant, independent risk factor for the development and progression of cardiovascular diseases, including carotid artery disease, which is strongly correlated with an elevated risk of ischemic events and stroke. This systematic review aims to determine the impact of elevated Lp(a) levels on the postoperative outcomes in patients undergoing carotid endarterectomy (CEA). Methods: Four electronic databases-PubMed, Scopus, Web of Science, and Cochrane Library-were employed to search for studies assessing the association between elevated Lp(a) levels and the postoperative outcomes following CEA. The effect of elevated Lp(a) levels was systematically reviewed, and the outcomes reported in each study were evaluated. The quality of the studies was evaluated using the National Heart, Lung, and Blood Institute Study Quality Assessment Tool for observational cohorts and cross-sectional studies. Results: A total of five observational studies were included, with 1450 patients. The mean age of the participants in the studies ranged from 57 to 74 years, and the percentage of males ranged from 37.22% to 68.96%. One study showed that elevated Lp(a) levels were significantly associated with major adverse cardiovascular events (MACEs) after CEA, particularly periprocedural stroke, with another manuscript suggesting a long-term predictive value for acute coronary syndromes (ACSs) within 24 months following surgery. There was no association in the included studies with carotid plaque instability, inflammation biomarkers, or restenosis. Conclusions: This systematic review suggests an association of Lp(a) levels with MACEs and ACSs after CEA although no association with restenosis and carotid plaque inflammation and/or instability.