The complex role of lipoprotein(a) in the pathophysiology of non-alcoholic fatty liver disease: A systematic review

Abstract

Aim: The aim of the present systematic review was to summarize the epidemiological studies that have examined the association between lipoprotein(a) (Lp(a)) and liver steatosis or fibrosis. Methods: A computer-assisted systematic literature search was performed by 2 independent experts for manuscripts that examined the association between Lp(a) and non-alcoholic fatty liver disease (NAFLD). Results: Overall, n=9 studies were considered as eligible for the present systematic review. In all studies participants’ origins were from Asian [n=4 from China, n=3 from Korea and n=1 from Japan] with only one study where participants were recruited from a clinic in Italy. In all studies, the association between Lp(a) and NAFLD was cross-sectional. In n=3 studies, the diagnosis of NAFLD accompanied by histological characteristics of non-alcoholic steatohepatitis (NASH) and liver fibrosis was performed with the gold standard method of liver biopsy. Four studies focused on the association between Lp(a) and liver fibrosis. Most of the selected studies revealed a significant inverse association between Lp(a) and liver fibrosis implying the use of the lipidemic molecule combined with conventional hepatic markers to detect advanced NAFLD stages. In addition to this and considering the aggravating role of Lp(a) in prediction of CVD onset, some scientific teams suggested that in case of advanced hepatic fibrosis this lipid marker should not be used as an indicator of vascular health. Conclusion: Additional studies are required to clarify the role of Lp(a) in NAFLD and other metabolic diseases in different reference populations.