{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T08:41:08Z","timestamp":1793868068798,"version":"4.6.1"},"reference-count":40,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Following Cochrane and PRISMA guidelines, we systematically searched PubMed\/MEDLINE, Embase, and Cochrane Central for studies of adults without ASCVD, elevated Lp(a) (\u226550\u2005mg\/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\u2013Knapp\u2013Sidik\u2013Jonkman (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\u20131.17; P = 0.1) or clinical bleeding events (HR = 1.24; 95% CI 0.83\u20131.87; 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwag207","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T11:52:26Z","timestamp":1775649146000},"source":"Crossref","is-referenced-by-count":6,"title":["Efficacy and safety of aspirin for primary prevention in adults with elevated lipoprotein(a) or genetic susceptibility\n                    <i>via LPA<\/i>\n                    gene variants: a systematic review and meta-analysis"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5560-2453","authenticated-orcid":false,"given":"Rodolfo A","family":"Lopes","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Memorial Healthcare System , Hollywood, FL 33021 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7618-4999","authenticated-orcid":false,"given":"Carlos A","family":"Vergara Sanchez","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mayo Clinic Florida , Jacksonville, FL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7973-1469","authenticated-orcid":false,"given":"Alfredo","family":"Perez Tagle Tejeda","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Memorial Healthcare System , Hollywood, FL 33021 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3698-260X","authenticated-orcid":false,"given":"Jordan","family":"Khorsandi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Memorial Healthcare System , Hollywood, FL 33021 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1900-9432","authenticated-orcid":false,"given":"Christian K","family":"Fukunaga","sequence":"additional","affiliation":[{"name":"Department of Medicine, Centro Universit\u00e1rio Faculdade de Medicina do ABC , Santo Andr\u00e9, S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7538-4423","authenticated-orcid":false,"given":"Eric","family":"Katsuyama","sequence":"additional","affiliation":[{"name":"Department of Medicine, Centro Universit\u00e1rio Faculdade de Medicina do ABC , Santo Andr\u00e9, S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2409-7675","authenticated-orcid":false,"given":"Juan Armando","family":"Talavera","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mount Sinai Medical Center , Miami Beach, FL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3945-7529","authenticated-orcid":false,"given":"Eugene","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of Washington School of Medicine , Seattle, WA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9071-3287","authenticated-orcid":false,"given":"Michael D","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine. 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