Elevated lipoprotein(a) and cardiovascular outcomes in prediabetes and diabetes: a systematic review and meta-analysis
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.032 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.018 | 0.033 |
| Bibliometrics | 0.008 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".