Higher Lp(a) predicts worse long-term outcomes after heart attack, especially in women and patients with diabetes or hypertension, meta-analysis of 30,027 patients finds (Rev Cardiovasc Med 2025)

Original title: The Association of Lipoprotein(a) with Major Adverse Cardiovascular Events after Acute Myocardial Infarction: A Meta-Analysis of Cohort Studies

Rev Cardiovasc Med · 1 May 2025 · 7

Liu H, Wang L, Wang H, Hao X, Du Z, Li C, Hou X

This meta-analysis (PROSPERO CRD42024511985) pooled 23 cohorts totalling 30,027 individuals surviving acute myocardial infarction (AMI) to clarify Lp(a)'s prognostic association with major adverse cardiovascular events (MACE). Compared with the lowest Lp(a) category, the highest category carried higher MACE risk (HR 1.05, 95% CI 1.01-1.09, P = 0.006), a pattern confirmed when Lp(a) was analysed continuously (HR 1.14, 95% CI 1.02-1.26, P = 0.02). Subgroup analyses showed the association was significant among women (HR 1.23, P = 0.005), patients with diabetes (HR 1.39, P = 0.01) or hypertension (HR 1.36, P < 0.00001), both STEMI (HR 1.03, P = 0.04) and non-STEMI (HR 1.40, P = 0.03) presentations, and specifically for long-term MACE beyond one year (HR 1.41, P = 0.0006). The authors conclude higher Lp(a) is an independent indicator of MACE risk after AMI, most useful for identifying long-term risk, particularly among women with diabetes and/or hypertension.

Original abstract

Background: Despite evidence suggesting a link between lipoprotein(a) (Lp(a)) and the occurrence of acute myocardial infarction (AMI), the relationship regarding prognoses related to AMI remains unclear. This meta-analysis was conducted to summarize the association between Lp(a) and the risks of major adverse cardiovascular events (MACEs) among populations surviving AMI.

Methods: We searched PubMed, Embase, Web of Science, MEDLINE, and Cochrane Library databases until February 14, 2024. Cohort studies reporting multivariate-adjusted hazard ratios (HRs) for the correlation of Lp(a) with MACEs in AMI populations were identified. The Lp(a) level was analyzed using categorical and continuous variables. Subgroup analyses were conducted based on gender, type of AMI, diabetic and hypertensive status. Publication bias was assessed using funnel plots. A random-effect model was utilized to pool the results.

Results: In total, 23 cohorts comprising 30,027 individuals were recruited. In comparison to those categorized with the lowest serum Lp(a), individuals in the highest category showed higher risks of MACEs after AMI (HR: 1.05, 95% confidence interval (CI): 1.01-1.09, p = 0.006). Similar findings were exhibited when Lp(a) was analyzed as a continuous variable (HR: 1.14, 95% CI: 1.02-1.26, p = 0.02). Subgroup analyses indicated that this correlation persisted significantly among females (HR: 1.23, p = 0.005), diabetes mellitus (DM) (HR: 1.39, p = 0.01), hypertension (HR: 1.36, p < 0.00001), ST-segment elevation myocardial infarction (STEMI) (HR: 1.03, p = 0.04), non-STEMI (HR: 1.40, p = 0.03), and long-term (>1 year) MACE (HR: 1.41, p = 0.0006) subgroups.

Conclusions: Higher Lp(a) levels might be an independent indicator for MACE risks after AMI, especially among female populations with DM and/or hypertension, and more suitable for evaluating long-term MACEs.

The Prospero Registration: CRD42024511985, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024511985.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.