TY - JOUR
T1 - Circulating lipoprotein (a) and all-cause and cause-specific mortality
T2 - a systematic review and dose-response meta-analysis
AU - Amiri, Mojgan
AU - Raeisi-Dehkordi, Hamidreza
AU - Verkaar, Auke J.C.F.
AU - Wu, Yahong
AU - van Westing, Anniek C.
AU - Berk, Kirsten A.
AU - Bramer, Wichor M.
AU - Aune, Dagfinn
AU - Voortman, Trudy
N1 - Funding Information:
HR-D, AVW, and YW have received funding for their PhD trajectories by the Swiss National Science Foundation under the SPIRIT grant (SNSF IZSTZ0_190277), Jaap Schouten Foundation, and China Scholarship Council (CSC) (file number: 202008500141), respectively. The funding agencies had no role in the study (conceptualization, design, data collection, analysis, and writing). MA appreciates Dr. Amine Amiri for her valuable advice and consolations on this project.
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/5
Y1 - 2023/5
N2 - Aims: To investigate the association between circulating lipoprotein(a) (Lp(a)) and risk of all-cause and cause-specific mortality in the general population and in patients with chronic diseases, and to elucidate the dose-response relations. Methods and results: We searched literature to find prospective studies reporting adjusted risk estimates on the association of Lp(a) and mortality outcomes. Forty-three publications, reporting on 75 studies (957,253 participants), were included. The hazard ratios (HRs) and 95% confidence intervals (95%CI) for the top versus bottom tertile of Lp(a) levels and risk of all-cause mortality were 1.09 (95%CI: 1.01–1.18, I2: 75.34%, n = 19) in the general population and 1.18 (95%CI: 1.04–1.34, I2: 52.5%, n = 12) in patients with cardiovascular diseases (CVD). The HRs for CVD mortality were 1.33 (95%CI: 1.11–1.58, I2: 82.8%, n = 31) in the general population, 1.25 (95%CI: 1.10–1.43, I2: 54.3%, n = 17) in patients with CVD and 2.53 (95%CI: 1.13–5.64, I2: 66%, n = 4) in patients with diabetes mellitus. Linear dose-response analyses revealed that each 50 mg/dL increase in Lp(a) levels was associated with 31% and 15% greater risk of CVD death in the general population and in patients with CVD. No non-linear dose-response association was observed between Lp(a) levels and risk of all-cause or CVD mortality in the general population or in patients with CVD (Pnonlinearity > 0.05). Conclusion: This study provides further evidence that higher Lp(a) levels are associated with higher risk of all-cause mortality and CVD-death in the general population and in patients with CVD. These findings support the ESC/EAS Guidelines that recommend Lp(a) should be measured at least once in each adult person’s lifetime, since our study suggests those with higher Lp(a) might also have higher risk of mortality.
AB - Aims: To investigate the association between circulating lipoprotein(a) (Lp(a)) and risk of all-cause and cause-specific mortality in the general population and in patients with chronic diseases, and to elucidate the dose-response relations. Methods and results: We searched literature to find prospective studies reporting adjusted risk estimates on the association of Lp(a) and mortality outcomes. Forty-three publications, reporting on 75 studies (957,253 participants), were included. The hazard ratios (HRs) and 95% confidence intervals (95%CI) for the top versus bottom tertile of Lp(a) levels and risk of all-cause mortality were 1.09 (95%CI: 1.01–1.18, I2: 75.34%, n = 19) in the general population and 1.18 (95%CI: 1.04–1.34, I2: 52.5%, n = 12) in patients with cardiovascular diseases (CVD). The HRs for CVD mortality were 1.33 (95%CI: 1.11–1.58, I2: 82.8%, n = 31) in the general population, 1.25 (95%CI: 1.10–1.43, I2: 54.3%, n = 17) in patients with CVD and 2.53 (95%CI: 1.13–5.64, I2: 66%, n = 4) in patients with diabetes mellitus. Linear dose-response analyses revealed that each 50 mg/dL increase in Lp(a) levels was associated with 31% and 15% greater risk of CVD death in the general population and in patients with CVD. No non-linear dose-response association was observed between Lp(a) levels and risk of all-cause or CVD mortality in the general population or in patients with CVD (Pnonlinearity > 0.05). Conclusion: This study provides further evidence that higher Lp(a) levels are associated with higher risk of all-cause mortality and CVD-death in the general population and in patients with CVD. These findings support the ESC/EAS Guidelines that recommend Lp(a) should be measured at least once in each adult person’s lifetime, since our study suggests those with higher Lp(a) might also have higher risk of mortality.
KW - Cardiovascular disease
KW - Cause of death
KW - Chronic disease
KW - Cohort studies
KW - Heart disease risk factors
KW - Lipoprotein(a)
KW - Meta-analysis
KW - Mortality
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=85146918213&partnerID=8YFLogxK
U2 - 10.1007/s10654-022-00956-4
DO - 10.1007/s10654-022-00956-4
M3 - Review article
C2 - 36708412
AN - SCOPUS:85146918213
SN - 0393-2990
VL - 38
SP - 485
EP - 499
JO - European Journal of Epidemiology
JF - European Journal of Epidemiology
IS - 5
ER -