# Aspirine voor primaire preventie bij verhoogd Lp(a) of LPA-varianten levert geen significante winst op

*geplaatst 2026-06-19 · Cholesterol · European journal of preventive cardiology · doi 10.1093/eurjpc/zwag207 · https://hartvaat.nl/2026/05/15/aspirine-voor-primaire-preventie-bij-verhoogd-lp-a-of-lpa-varianten-levert-geen-/*

Systematische review en meta-analyse van 6 studies (totaal 6.628 deelnemers) over aspirine voor primaire preventie bij volwassenen zonder ASCVD met verhoogd lipoproteïne(a) (≥50 mg/dL), hoog-risico LPA-genotypen of verhoogde genetische risicoscores. Gepoolde analyse toonde geen significante reductie van major adverse cardiovascular events (HR 0,60; 95%-BI 0,31-1,17; p=0,10) en evenmin een significante stijging van klinische bloedingen (HR 1,24; p=0,18). Subgroep-analyses toonden een niet-significante reductie bij verhoogd Lp(a) (HR 0,63) en een statistisch significante reductie bij dragers van LPA rs3798220 (HR 0,37; 95%-BI 0,19-0,71), maar deze laatste bleek inconsistent in sensitiviteitsanalyses en weerspiegelt waarschijnlijk small-sample bias. De aanwijzingen ondersteunen geen routinematig aspirine-advies bij asymptomatische volwassenen met hoog Lp(a) of risico-LPA-varianten.

## English: 

Systematic review and meta-analysis of 6 studies (total 6,628 participants) on aspirin for primary prevention in adults without ASCVD with elevated lipoprotein(a) (≥50 mg/dL), high-risk LPA genotypes, or elevated genetic risk scores. Pooled analysis showed no significant reduction in major adverse cardiovascular events (HR 0.60; 95% CI 0.31-1.17; p=0.10) and no significant increase in clinical bleeding (HR 1.24; p=0.18). Subgroup analyses showed a non-significant reduction with elevated Lp(a) (HR 0.63) and a statistically significant reduction in LPA rs3798220 carriers (HR 0.37; 95% CI 0.19-0.71), but the latter was inconsistent on sensitivity analysis and likely reflects small-sample bias. The evidence does not support routine aspirin in asymptomatic adults with high Lp(a) or risk-LPA variants.

## Abstract (original, from the publication)

AIMS: Routine aspirin use for primary prevention yields modest cardiovascular benefit but increases bleeding risk in average-risk adults. Whether individuals with elevated lipoprotein(a) [Lp(a)] levels or high-risk LPA variants derive greater benefit remains uncertain. METHODS AND RESULTS: Following Cochrane and PRISMA guidelines, we systematically searched PubMed/MEDLINE, Embase, and Cochrane Central for studies of adults without ASCVD, elevated Lp(a) (≥50 mg/dL), high-risk LPA genotypes, or elevated genetic risk scores, comparing aspirin vs. no aspirin use. Random-effects meta-analyses using restricted maximum-likelihood (REML) estimation with Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment were used to pool hazard ratios (HR) and 95% confidence intervals (CI). In six studies, 6628 participants were included. Pooled random effects showed no significant reduction in major adverse cardiovascular events (MACE) with aspirin (HR = 0.60; 95% CI 0.31-1.17; P = 0.1) or clinical bleeding events (HR = 1.24; 95% CI 0.83-1.87; P = 0.18). Subgroup analyses showed a nonsignificant reduction MACE among elevated Lp(a) (HR = 0.63; 95% CI 0.16 to 2.49; P = 0.284) and statistically significant reduction among LPA rs3798220 carriers (HR = 0.37; 95% CI 0.19 to 0.71; P = 0.003), though this finding was not consistent in the sensitivity analyses. CONCLUSION: Among adults without ASCVD but with elevated Lp(a) or high-risk LPA genotypes, aspirin use did not confer a statistically significant cardiovascular benefit and was associated with numerically higher bleeding risk. The apparent reduction seen in rs3798220 carriers was inconsistent and likely reflects small-sample bias.

Auteurs: Rodolfo A Lopes, Carlos A Vergara Sanchez, Alfredo Perez Tagle Tejeda, Jordan Khorsandi, Christian K Fukunaga, Eric Katsuyama, Juan Armando Talavera, Eugene Yang, Michael D Shapiro

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Bron: European journal of preventive cardiology, https://doi.org/10.1093/eurjpc/zwag207. Bijgewerkt 2026-07-03T13:31:59Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.