The role of lipoprotein(a) in atrial fibrillation: a systematic review

KEy wORdsatrial fibrillation, biomarker, lipoprotein(a), risk factor AbsTRACTINTROduCTION Atrial fibrillation (AF) is the most prevalent form of cardiac arrhythmia worldwide.Early diagnosis and treatment are essential, emphasizing the need to develop novel biomarkers.Lipoprotein(a) (Lp[a]) has recently been widely investigated as a potential risk factor for various cardiovascular conditions, including AF.ObjECTIvEs Our objective was to systematically review the current knowledge on the role of Lp(a) in AF.METhOds This systematic review adhered to the PRISMA 2020 guidelines.We included full -text original clinical studies in English assessing the role of Lp(a) in AF.A comprehensive search in 5 databases: Embase, MEDLINE Ultimate, PubMed, Scopus, and Web of Science yielded 26 original, relevant clinical research articles that we analyzed in this study. REsuLTsStudies investigating the association between Lp(a) level and the incidence of AF present conflicting findings.However, Mendelian randomization studies advocate a causal association between high Lp(a) levels and AF.Research data suggest that AF patients who experience stroke or other thromboembolic events tend to have higher Lp(a) levels than those not experiencing such events.CONCLusIONs Existing data suggest Lp(a) may play a pathophysiological role in AF patients, especially those who experience thromboembolic events.Nevertheless, this field requires further research due to inconsistencies in the existing evidence.the incidence of AF? 2) Is there a causal relationship between Lp(a) level and AF occurrence? 3) Can Lp(a) level predict thromboembolic events in patients with AF? METhOds This systematic review was conducted in accordance with the PRISMA 2020 guidelines 22 (Supplementary material, Table S1).Full -text original clinical studies in English assessing the role of Lp(a) in AF were included.Systematic reviews, meta -analyses, reviews, case reports, letters to editors, commentaries, conference abstracts, guidelines / statements, expert opinions, and preprints were excluded.A comprehensive search was conducted on October 22, 2024 in 5 databases: Embase, MEDLINE Ultimate, PubMed, Scopus, and Web of Science.The following query was utilized: (lipoprotein(a) OR lp(a) OR lipoprotein [a] OR lp [a] OR lipoprotein a OR lp a) AND (atrial fibrillation OR atrial fibrilation), which yielded a total of 647 records.GP screened the records and extracted data from each included work.The following data were extracted from each research study: study characteristics (sample sizes, methodology used, year of publication, study type) and the main findings regarding Lp(a) in the context of AF.After removing 394 duplicates, the remaining 253 records were screened by title and abstract.This yielded 29 records that met the inclusion criteria.All 29 studies were retrieved in a complete form.The entire data report was evaluated for eligibility, and further 3 studies were excluded: 1 due to the paper type (research letter, not full -text original research), 1 due to low -quality data (the research focused on gut microbiota in the context of AF, while Lp[a] was one of the multiple additional factors analyzed), and 1 due to non -English language.Finally, 26 original clinical research articles relevant to the discussed area were included (FIGuRE 1).The quality of the included studies in terms of the aim of this systematic review was assessed using the Newcastle -Ottawa Scale for assessing the quality of nonrandomized case -control studies 23 (Supplementary material, Table S2).The included studies were divided into the following groups: 1) Lp(a) and the association with AF; 2) Lp(a) as a causal risk factor of AF in Mendelian randomization studies; 3) Lp(a) as a predictor of thromboembolic events in patients with AF; and 4) Lp(a) correlation with the presence of left atrial (LA) thrombus (LAT) in patients with AF.REsuLTs Lipoprotein(a) and the association with atrial fibrillation Díaz -Peromingo et al 24 recruited 101 patients with AF and an equivalent number of patients without AF, matched for sex and age.They compared Lp(a) concentrations between the groups and found no significant differences.Nevertheless, they included a relatively small number of patients, which might have potentially influenced the results.Naji et al 25 identified