Association Between Lipoprotein-Associated Phospholipase A2 Levels and Risk of Recurrent Cerebrovascular Events in Patients With Ischemic Stroke: A Systematic Review and Meta-Analysis.

OBJECTIVE: To systematically evaluate the association between lipoprotein-associated phospholipase A2 (Lp-PLA2) levels and the risk of recurrent cerebrovascular events in patients with ischemic stroke. METHODS: PubMed, Web of Science, Embase, the Cochrane Library, and China National Knowledge Infrastructure were systematically searched from inception to May 20, 2026. Observational studies reporting the association between Lp-PLA2 levels and the risk of recurrent cerebrovascular events in patients with ischemic stroke were included. The primary outcome was recurrent cerebrovascular events, mainly including ischemic stroke, acute cerebral infarction, or cerebral infarction recurrence. Because studies comparing high versus low Lp-PLA2 levels reported both hazard ratios (HR) and odds ratios (OR), the pooled results were expressed as pooled relative effect estimates with 95% confidence intervals (CI). For the continuous-variable analysis, effect estimates were rescaled and expressed as ORs per 1 standard deviation (SD) increase in Lp-PLA2. All meta-analyses were performed using random-effects models. RESULTS: Ten studies involving 2,527 patients with ischemic stroke were included in the meta-analysis. Higher Lp-PLA2 levels were associated with an increased risk of recurrent cerebrovascular events (pooled relative effect estimate = 2.99, 95% CI 2.24-3.99; P < 0.001). After excluding the study that did not report the cutoff value for the high and low Lp-PLA2 groups, the association remained stable (pooled relative effect estimate = 2.76, 95% CI 2.20-3.47; P < 0.001). In the continuous-variable analysis, each 1-SD increase in Lp-PLA2 was associated with an increased risk of recurrent cerebrovascular events (pooled OR = 2.62, 95% CI 1.08-6.33; P = 0.033). CONCLUSION: Higher Lp-PLA2 levels are associated with an increased risk of recurrent cerebrovascular events in patients with ischemic stroke. Lp-PLA2 may be a promising prognostic marker for secondary prevention after ischemic stroke.