A Systematic Review and Meta-Analysis of Elevated Lipoprotein(a) and Adverse Limb Outcomes in Peripheral Artery Disease After Revascularization

Systematic review and meta-analysis of observational cohort studies. Key findingsIn 10 observational studies (n = 5,794), elevated lipoprotein(a) was associated with higher peripheral arterial disease prevalence (OR, 1.81; 95% CI, 1.37-2.39).After lower-extremity revascularization, elevated lipoprotein(a) was associated with increased risk of repeat targetlesion revascularization (TLR) (OR, 3.22), major adverse limb events (OR, 5.09), and major amputation (OR, 2.62), with no heterogeneity. Take home messageElevated lipoprotein(a) identifies patients with peripheral artery disease at heightened limbrelated risk after lower-extremity revascularization and may assist postprocedural risk stratification and surveillance, although current evidence does not establish it as a therapeutic target for PAD-specific outcome modification. TABLE OF CONTENTS SUMMARYThis systematic review and meta-analysis demonstrate that elevated lipoprotein(a) is associated with increased peripheral artery disease prevalence and significantly worse limbrelated outcomes following lower-extremity revascularization.Lipoprotein(a) appears to be a clinically relevant prognostic biomarker that may help refine limb-related risk stratification and surveillance strategies in patients with peripheral artery disease, although PAD-specific therapeutic benefit from targeted lowering remains unproven.