Impact of Aspirin on Primary Prevention of Cardiovascular Events in Patients with Elevated Lipoprotein(a): A Systematic Review and Meta-analysis
Caldeira D, Alves M, Avó-Baião R, Lopes A, Prada L, Pinto FJ
American journal of cardiovascular drugs : drugs, devices, and other interventions · 0 citas
Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación independiente
- Universidad u hospital
- Universidade de Lisboa
Según 1 financiador declarado y la declaración de financiación del texto completo.
Publicación
- Publicado
- 2026-04-22 · Am J Cardiovasc Drugs · vol. 26 · número 5 · págs. 559–570
- Editorial
- Adis, Springer Healthcare
- Citado
- 0 citas · más que el 22% de estudios similares · 0.0× el promedio de su campo
- Referencias
- 24 trabajos
- Acceso
- Acceso abierto (revista híbrida) · CC-BY-NC
- Áreas de investigación
- Antiplatelet Therapy and Cardiovascular Diseases · Lipoproteins and Cardiovascular Health · Acute Myocardial Infarction Research
- Palabras clave
- aspirin, lipoprotein(a), primary prevention, major adverse cardiovascular events, myocardial infarction, coronary artery disease, cardiovascular mortality, bleeding risk, rs3798220, genetic variants, cardiovascular risk factors
- MeSH
- humans, cardiovascular diseases, hemorrhage, aspirin, lipoprotein(a), primary prevention
6 autores
- Daniel Caldeira🇵🇹 · autor de correspondenciaUniversity of Lisbon; Centro Cardiovascular da Universidade de Lisboa; Centro Académico de Medicina de Lisboa; Centro de Estudos de Medicina Baseada na Evidência
- M Diaz Gon alves🇵🇹University of Lisbon; Unidade Local de Saúde Santa Maria
- Rita Avó-Baião🇵🇹University of Lisbon
- Andreia Robert Lopes🇵🇹University of Lisbon
- Luísa Prada🇵🇹IPO Porto; Centro de Investigação do Instituto Português de Oncologia do Porto Francisco Gentil; RISE - Health Research Network
- Fausto José Pinto🇵🇹University of Lisbon; Centro Cardiovascular da Universidade de Lisboa; Centro Académico de Medicina de Lisboa
Resumen
El texto original del estudio, en el idioma en que se publicó.
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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