Impact of Aspirin on Primary Prevention of Cardiovascular Events in Patients with Elevated Lipoprotein(a): A Systematic Review and Meta-analysis.

IF 3 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiovascular Drugs Pub Date : 2026-04-22 DOI:10.1007/s40256-026-00795-8

Daniel Caldeira, Mariana Alves, Rita Avó-Baião, Andreia Lopes, Luisa Prada, Fausto J Pinto

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引用次数: 0

Abstract

Introduction: Elevated lipoprotein(a) (Lp(a)) and Lp(a)-raising genetic variants (e.g. rs3798220) are independent cardiovascular risk factors lacking preventive strategies. Given the prothrombotic properties attributed to high Lp(a), aspirin was hypothesized to confer benefit in primary prevention. We performed a systematic review and meta-analysis to evaluate the impact of aspirin on cardiovascular and bleeding outcomes in this population.

Methods: MEDLINE, Web of Science and CENTRAL were searched (November 2025) for randomized and observational studies assessing aspirin use in primary prevention among individuals with Lp(a) ≥ 50 mg/dL or Lp(a)-associated genetic variants. The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes included myocardial infarction (MI), coronary artery disease (CAD), cardiovascular mortality, and bleeding. Random-effects meta-analyses pooled the Hazard ratios (HR) with 95% confidence intervals (CI). Certainty of evidence was assessed using GRADE.

Results: Seven studies including 6498 participants met inclusion criteria. Aspirin was not associated with a reduction in MACE (HR 0.99, 95% CI 0.79-1.24; I² = 23%; four studies). MACE reduction was associated with aspirin in rs3798220-C carriers (HR 0.39, 95% CI 0.19-0.77, two studies). Aspirin was also associated with significant reduction of events regarding MI (HR 0.60, 95% CI 0.41-0.88, two studies) and cardiovascular mortality (HR 0.48, 95% CI 0.28-0.83, one study), whereas CAD was not significantly reduced (HR 0.82, 95% CI 0.59-1.12). Bleeding risk was numerically higher but not statistically significant (HR 1.13, 95% CI 0.89-1.44). Overall certainty of evidence was very low.

Conclusions: Aspirin was not associated with a reduction of MACE among individuals with elevated Lp(a). A potential benefit for MI requires confirmation in adequately designed and powered prospective studies. Pooled data from rs3798220-C carriers suggest a potential significant benefit that warrants further investigation REGISTRATION: PROSPERO identifier no. CRD42024520731.

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阿司匹林对高脂蛋白患者心血管事件一级预防的影响(a)：系统回顾和荟萃分析

简介：脂蛋白(a)升高（Lp(a)）和Lp(a)升高的遗传变异（如rs3798220）是缺乏预防策略的独立心血管危险因素。考虑到高Lp(a)导致的血栓形成特性，阿司匹林被假设在一级预防中具有益处。我们进行了系统回顾和荟萃分析，以评估阿司匹林对该人群心血管和出血结局的影响。方法：检索MEDLINE、Web of Science和CENTRAL（2025年11月）的随机和观察性研究，评估Lp(a)≥50 mg/dL或Lp(a)相关遗传变异个体使用阿司匹林的一级预防效果。主要终点为主要不良心血管事件（MACE）。次要结局包括心肌梗死（MI）、冠状动脉疾病（CAD）、心血管死亡率和出血。随机效应荟萃分析将风险比（HR）与95%置信区间（CI）合并。使用GRADE评估证据的确定性。结果：7项研究6498名受试者符合纳入标准。阿司匹林与MACE降低无关（HR 0.99, 95% CI 0.79-1.24; I2 = 23%； 4项研究）。在rs3798220-C携带者中，MACE降低与阿司匹林相关（HR 0.39, 95% CI 0.19-0.77，两项研究）。阿司匹林还与心肌梗死（HR 0.60, 95% CI 0.41-0.88，两项研究）和心血管死亡率（HR 0.48, 95% CI 0.28-0.83，一项研究）相关，而CAD没有显著降低（HR 0.82, 95% CI 0.59-1.12）。出血风险在数字上较高，但无统计学意义（HR 1.13, 95% CI 0.89-1.44）。证据的总体确定性非常低。结论：在Lp(a)升高的个体中，阿司匹林与MACE的降低无关。心肌梗死的潜在益处需要在充分设计和支持的前瞻性研究中得到证实。来自rs3798220-C携带者的汇总数据表明，潜在的显著益处值得进一步研究。CRD42024520731。

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来源期刊

American Journal of Cardiovascular Drugs 医学-心血管系统

CiteScore

6.70

自引率

3.30%

发文量

审稿时长

>12 weeks

期刊介绍： Promoting rational therapy within the discipline of cardiology, the American Journal of Cardiovascular Drugs covers all aspects of the treatment of cardiovascular disorders, particularly the place in therapy of newer and established agents. Via a program of reviews and original clinical research articles, the journal addresses major issues relating to treatment of these disorders, including the pharmacology, efficacy and adverse effects of the major classes of drugs; information on newly developed drugs and drug classes; the therapeutic implications of latest research into the aetiology of cardiovascular disorders; and the practical management of specific clinical situations. The American Journal of Cardiovascular Drugs offers a range of additional enhanced features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist patients, caregivers and others in understanding important medical advances. The journal also provides the option to include various other types of enhanced features including slide sets, videos and animations. All enhanced features are peer reviewed to the same high standard as the article itself. Peer review is conducted using Editorial Manager®, supported by a database of international experts. This database is shared with other Adis journals.