SERUM LIPOPROTEIN(A) AS AN INDEPENDENT PREDICTOR OF ADVERSE CARDIOVASCULAR EVENTS IN ADULTS: AN INTEGRATIVE LITERATURE REVIEW

Abstract

Objective: To evaluate the prognostic impact of serum lipoprotein(a) as an independent predictor of adverse atherothrombotic cardiovascular outcomes in adults. Methods: Integrative review conducted on September 29, 2026, across PubMed/MEDLINE, SciELO, and LILACS databases, covering publications between 2021 and 2026 in Portuguese, English, and Spanish. From 209 identified and 179 screened records, 30 studies were included (18 prospective cohorts, 11 retrospective cohorts, and one randomized clinical trial), encompassing data from 16 countries. Results: Elevated serum lipoprotein(a) concentrations were associated with recurrent acute myocardial infarction, in-stent restenosis, and cardiovascular mortality. In individuals under 60 years of age, elevated baseline levels doubled the risk of premature atherosclerosis and multivessel disease, and increased the incidence of atherothrombotic ischemic stroke, without correlation with intracranial hemorrhage. Active vascular inflammation (elevated interleukin-6 and high-sensitivity C-reactive protein) and metabolic dysfunction-associated steatotic liver disease potentiated ischemic risk. Conversely, in cohorts with diabetes mellitus under intensive secondary prevention, the predictive value of the particle for composite outcomes lost statistical significance. Conclusion: Elevated lipoprotein(a) represents an independent biomarker of residual atherothrombotic risk in adults, particularly in the presence of concomitant vascular inflammation, supporting individualized clinical risk stratification.