Association between elevated lipoprotein (a) and venous thromboembolism: A systematic review and meta-analysis.
Mahmoud Abdelnabi, Chanokporn Puchongmart, Ramzi Ibrahim et al.
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In 30 seconds
This systematic review and meta-analysis examined observational evidence on elevated lipoprotein(a) [Lp(a)] and venous thromboembolism (VTE). Across 11 studies involving 63,325 participants and 3581 VTE events, elevated Lp(a) had a borderline association with VTE (pooled OR/HR 1.34 [95% CI 1.00-1.80]; P = 0.049), with high heterogeneity (I 2 = 77.8%). Results differed by design: case-control studies showed an association, but prospective cohort studies did not. The authors conclude that cohort evidence does not support an association and that bias or residual confounding may explain the overall finding.
Key findings
- Across all studies, elevated Lp(a) was associated with borderline higher VTE risk: pooled OR/HR 1.34 [95% CI 1.00-1.80]; P = 0.049.
- Case-control studies showed an association (OR 1.88 [1.25-2.81]; I 2 = 57.2%), whereas cohort studies did not (HR 0.99 [0.85-1.15]; I 2 = 0%).
- Between-group differences by study design were significant (p < 0.0001); overall heterogeneity was high (I 2 = 77.8%).
Why it matters
The differing results by study design make the relationship between Lp(a) and VTE uncertain. The absence of an association in prospective cohort studies cautions against interpreting the pooled estimate as evidence that elevated Lp(a) predicts VTE. Clarifying whether the case-control finding reflects bias, residual confounding, or a true relationship will require further research.
What to keep in mind
The evidence is observational and heterogeneous; the pooled estimate has a wide prediction interval (0.56-3.21), and cohort studies showed no association.