{"title":"糖尿病前期和糖尿病患者的脂蛋白（a）升高与心血管后果：系统综述和荟萃分析。","authors":"Sidhartha Gautam Senapati, Vamsikalyan Borra, Lakshmi Prasanna Vaishnavi Kattamuri, Naga Vamsi Krishna Machineni, Nithya Borra, Sindhuja Kukkala, Karthikeya Ramasahayam, Kesar Prajapati, Parth R Nayak, Santosh Kale, Akhil Jain, Ankit Vyas, Rupak Desai","doi":"10.21037/cdt-24-162","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Elevated levels of lipoprotein(a) [Lp(a)] and diabetes have been identified as potential risk factors for coronary artery disease (CAD). This study investigates various Lp(a) levels' impact on atherosclerotic cardiovascular disease (ASCVD) events in pre-diabetics and diabetics.</p><p><strong>Methods: </strong>We included retrospective studies in English until May 2023, exploring the link between high Lp(a) levels and cardiovascular outcomes in humans with diabetes, prediabetes, or normal glucose levels. Studies were sourced from PubMed, Scopus, and Google Scholar, emphasizing detailed population and outcome data. We excluded studies with major methodological issues, low-quality data, missing key information, duplicates, and non-human subjects. We included high-quality retrospective studies on Lp(a) and cardiovascular outcomes, using risk of bias tools like Newcastle-Ottawa Scale (NOS) to ensure data integrity, and resolved discrepancies through discussion. Binary random-effects models were employed to estimate pooled hazard ratios (HRs) and 95% confidence intervals (CIs). Leave one out sensitivity analysis was performed. Heterogeneity was assessed using I<sup>2</sup> statistics. For outcomes showing moderate or high heterogeneity, subgroup analyses were performed for follow-up duration or type of study.</p><p><strong>Results: </strong>A total of 20,271 patients with diabetes, prediabetes, and non-diabetics were included from three studies. In our analysis, compared to non-diabetics with Lp(a) <10 mg/dL, the risk of ASCVD increased with an increase in Lp(a) levels among pre-diabetics [Lp(a) <10 mg/dL (HR: 1.40, 95% CI: 1.17-1.67), Lp(a) 10-30 mg/dL (HR: 1.60, 95% CI: 1.30-1.96), Lp(a) >30 mg/dL (HR: 2.08, 95% CI: 1.49-2.90)] and diabetics [Lp(a) <10 mg/dL (HR: 2.42, 95% CI: 1.97-2.98), Lp(a) 10-30 mg/dL (HR: 2.26, 95% CI: 1.64-3.12), Lp(a) >30 mg/dL (HR: 4.17, 95% CI: 3.24-5.37)] with statistical significance (P<0.01).</p><p><strong>Conclusions: </strong>High Lp(a) (>30 mg/dL) is associated with more ASCVD events in diabetics and pre-diabetics <i>vs</i>. Lp(a) <30 mg/dL, underscoring Lp(a)'s clinical importance in risk stratification and intervention.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 1","pages":"163-172"},"PeriodicalIF":2.1000,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921399/pdf/","citationCount":"0","resultStr":"{\"title\":\"Elevated lipoprotein(a) and cardiovascular outcomes in prediabetes and diabetes: a systematic review and meta-analysis.\",\"authors\":\"Sidhartha Gautam Senapati, Vamsikalyan Borra, Lakshmi Prasanna Vaishnavi Kattamuri, Naga Vamsi Krishna Machineni, Nithya Borra, Sindhuja Kukkala, Karthikeya Ramasahayam, Kesar Prajapati, Parth R Nayak, Santosh Kale, Akhil Jain, Ankit Vyas, Rupak Desai\",\"doi\":\"10.21037/cdt-24-162\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Elevated levels of lipoprotein(a) [Lp(a)] and diabetes have been identified as potential risk factors for coronary artery disease (CAD). This study investigates various Lp(a) levels' impact on atherosclerotic cardiovascular disease (ASCVD) events in pre-diabetics and diabetics.</p><p><strong>Methods: </strong>We included retrospective studies in English until May 2023, exploring the link between high Lp(a) levels and cardiovascular outcomes in humans with diabetes, prediabetes, or normal glucose levels. Studies were sourced from PubMed, Scopus, and Google Scholar, emphasizing detailed population and outcome data. We excluded studies with major methodological issues, low-quality data, missing key information, duplicates, and non-human subjects. We included high-quality retrospective studies on Lp(a) and cardiovascular outcomes, using risk of bias tools like Newcastle-Ottawa Scale (NOS) to ensure data integrity, and resolved discrepancies through discussion. Binary random-effects models were employed to estimate pooled hazard ratios (HRs) and 95% confidence intervals (CIs). Leave one out sensitivity analysis was performed. Heterogeneity was assessed using I<sup>2</sup> statistics. For outcomes showing moderate or high heterogeneity, subgroup analyses were performed for follow-up duration or type of study.</p><p><strong>Results: </strong>A total of 20,271 patients with diabetes, prediabetes, and non-diabetics were included from three studies. In our analysis, compared to non-diabetics with Lp(a) <10 mg/dL, the risk of ASCVD increased with an increase in Lp(a) levels among pre-diabetics [Lp(a) <10 mg/dL (HR: 1.40, 95% CI: 1.17-1.67), Lp(a) 10-30 mg/dL (HR: 1.60, 95% CI: 1.30-1.96), Lp(a) >30 mg/dL (HR: 2.08, 95% CI: 1.49-2.90)] and diabetics [Lp(a) <10 mg/dL (HR: 2.42, 95% CI: 1.97-2.98), Lp(a) 10-30 mg/dL (HR: 2.26, 95% CI: 1.64-3.12), Lp(a) >30 mg/dL (HR: 4.17, 95% CI: 3.24-5.37)] with statistical significance (P<0.01).</p><p><strong>Conclusions: </strong>High Lp(a) (>30 mg/dL) is associated with more ASCVD events in diabetics and pre-diabetics <i>vs</i>. Lp(a) <30 mg/dL, underscoring Lp(a)'s clinical importance in risk stratification and intervention.</p>\",\"PeriodicalId\":9592,\"journal\":{\"name\":\"Cardiovascular diagnosis and therapy\",\"volume\":\"15 1\",\"pages\":\"163-172\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-02-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921399/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cardiovascular diagnosis and therapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.21037/cdt-24-162\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/2/25 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiovascular diagnosis and therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/cdt-24-162","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/25 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Elevated lipoprotein(a) and cardiovascular outcomes in prediabetes and diabetes: a systematic review and meta-analysis.
Background: Elevated levels of lipoprotein(a) [Lp(a)] and diabetes have been identified as potential risk factors for coronary artery disease (CAD). This study investigates various Lp(a) levels' impact on atherosclerotic cardiovascular disease (ASCVD) events in pre-diabetics and diabetics.
Methods: We included retrospective studies in English until May 2023, exploring the link between high Lp(a) levels and cardiovascular outcomes in humans with diabetes, prediabetes, or normal glucose levels. Studies were sourced from PubMed, Scopus, and Google Scholar, emphasizing detailed population and outcome data. We excluded studies with major methodological issues, low-quality data, missing key information, duplicates, and non-human subjects. We included high-quality retrospective studies on Lp(a) and cardiovascular outcomes, using risk of bias tools like Newcastle-Ottawa Scale (NOS) to ensure data integrity, and resolved discrepancies through discussion. Binary random-effects models were employed to estimate pooled hazard ratios (HRs) and 95% confidence intervals (CIs). Leave one out sensitivity analysis was performed. Heterogeneity was assessed using I2 statistics. For outcomes showing moderate or high heterogeneity, subgroup analyses were performed for follow-up duration or type of study.
Results: A total of 20,271 patients with diabetes, prediabetes, and non-diabetics were included from three studies. In our analysis, compared to non-diabetics with Lp(a) <10 mg/dL, the risk of ASCVD increased with an increase in Lp(a) levels among pre-diabetics [Lp(a) <10 mg/dL (HR: 1.40, 95% CI: 1.17-1.67), Lp(a) 10-30 mg/dL (HR: 1.60, 95% CI: 1.30-1.96), Lp(a) >30 mg/dL (HR: 2.08, 95% CI: 1.49-2.90)] and diabetics [Lp(a) <10 mg/dL (HR: 2.42, 95% CI: 1.97-2.98), Lp(a) 10-30 mg/dL (HR: 2.26, 95% CI: 1.64-3.12), Lp(a) >30 mg/dL (HR: 4.17, 95% CI: 3.24-5.37)] with statistical significance (P<0.01).
Conclusions: High Lp(a) (>30 mg/dL) is associated with more ASCVD events in diabetics and pre-diabetics vs. Lp(a) <30 mg/dL, underscoring Lp(a)'s clinical importance in risk stratification and intervention.
期刊介绍：
The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.
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