AIMS Lipoprotein(a) [Lp(a)] is a causal and independent risk factor for cardiovascular disease (CVD). People with elevated Lp(a) are often prescribed statins as they also often show elevated low-density lipoprotein cholesterol (LDL-C) levels. While statins are well-established in lowering LDL-C, their effect on Lp(a) remains unclear. We evaluated the effect of statins compared to placebo on Lp(a) and the effects of different types and intensities of statin therapy on Lp(a). METHODS AND RESULTS We conducted a systematic review and meta-analysis of randomized trials with a statin and placebo arm. Medline and EMBASE were searched until August 2019. Quality assessment of studies was done using Cochrane risk-of-bias tool (RoB 2). Mean difference of absolute and percentage changes of Lp(a) in the statin vs. the placebo arms were pooled using a random-effects meta-analysis. We compared effects of different types and intensities of statin therapy using subgroup- and network meta-analyses. Certainty of the evidence was determined using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Overall, 39 studies (24 448 participants) were included. Mean differences (95% confidence interval) of absolute and percentage changes in the statin vs. the placebo arms were 1.1 mg/dL (0.5-1.6, P < 0.0001) and 0.1% (-3.6% to 4.0%, P = 0.95), respectively (moderate-certainty evidence). None of the types of statins changed Lp(a) significantly compared to placebo (very low- to high-certainty evidence), as well as intensities of statin therapy (low- to moderate-certainty evidence). CONCLUSION Statin therapy does not lead to clinically important differences in Lp(a) compared to placebo in patients at risk for CVD. Our findings suggest that in these patients, statin therapy will not change Lp(a)-associated CVD risk.

中文翻译：

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他汀类药物治疗和脂蛋白（a）水平：系统评价和荟萃分析。

AIMS 脂蛋白(a) [Lp(a)] 是心血管疾病 (CVD) 的因果和独立危险因素。Lp(a) 升高的人通常会服用他汀类药物，因为他们的低密度脂蛋白胆固醇 (LDL-C) 水平也经常升高。虽然他汀类药物在降低 LDL-C 方面已得到公认，但它们对 Lp(a) 的影响仍不清楚。我们评估了他汀类药物与安慰剂相比对 Lp(a) 的影响，以及不同类型和强度的他汀类药物治疗对 Lp(a) 的影响。方法和结果 我们对他汀类药物和安慰剂组的随机试验进行了系统评价和荟萃分析。检索 Medline 和 EMBASE 至 2019 年 8 月。使用 Cochrane 偏倚风险工具 (RoB 2) 对研究进行质量评估。他汀类药物中 Lp(a) 绝对值和百分比变化的平均差异 安慰剂组使用随机效应荟萃分析进行汇总。我们使用亚组和网络荟萃分析比较了不同类型和强度的他汀类药物治疗的效果。使用 GRADE（推荐、评估、开发和评估的分级）确定证据的确定性。总体而言，纳入了 39 项研究（24 448 名参与者）。他汀类药物与安慰剂组的绝对变化和百分比变化的平均差异（95% 置信区间）分别为 1.1 mg/dL（0.5-1.6，P < 0.0001）和 0.1%（-3.6% 至 4.0%，P = 0.95） ，分别（中等质量证据）。与安慰剂相比，任何一种他汀类药物均未显着改变 Lp(a)（极低至高质量证据），以及他汀类药物治疗的强度（低至中等质量证据）。结论 在有心血管疾病风险的患者中，他汀类药物治疗与安慰剂相比不会导致临床上重要的 Lp(a) 差异。我们的研究结果表明，在这些患者中，他汀类药物治疗不会改变与 Lp(a) 相关的 CVD 风险。