The Impact of Elevated Lipoprotein(a) Levels on Postoperative Outcomes in Carotid Endarterectomy: A Systematic Review

Abstract

Abstract Background/Objectives Numerous studies have highlighted Lipoprotein(a) (Lp(a)) as a significant, independent risk factor for the development and progression of cardiovascular diseases, including carotid artery disease, which is strongly associated with an increased risk of ischemic events and stroke. This systematic review aims to determine the impact of elevated Lp(a) levels on postoperative outcomes in patients undergoing carotid endarterectomy (CEA). Methods Four electronic databases, PubMed, Scopus, Web of Science and Cochrane Library, were used to search for studies evaluating the association between elevated Lp(a) levels and postoperative outcomes following CEA. The effect of elevated Lp(a) levels was systematically reviewed, and the outcomes reported in each study were evaluated. Assessment of studies' quality was performed using the National Heart, Lung, and Blood Institute Study Quality Assessment Tool for observational cohorts and cross-sectional studies. Results A total of five observational studies were included with 1450 patients. The mean age of the participants in the studies ranged from 57 to 74 years, and the percentage of males ranged from 37.22% to 68.96%. A study showed that elevated Lp(a) levels are significantly associated with major adverse cardiovascular events (MACE) after CEA, particularly periprocedural stroke, with another manuscript suggesting a long-term predictive value for acute coronary syndromes (ACS) within 24 months following surgery. There was no association in the included studies with carotid plaque instability and/or inflammation biomarkers, as well as with restenosis. Conclusions This systematic review suggests an association of Lp(a) levels with MACE and ACS after CEA, although no association with restenosis and carotid plaque inflammation and/or instability.