Lipoprotein-associated phospholipase A2 and complications of diabetes mellitus: a systematic review and meta-analysis

Objective This systematic review aimed to assess whether lipoprotein-associated phospholipase A2 (Lp-PLA2) is associated with increased risk of complications in patients with diabetes mellitus (DM). Methods We searched PubMed, Embase, Web of Science, and Scopus databases for studies fulfilling the inclusion criteria till 30 June 2025. The relationship between Lp-PLA2 and cardiovascular disorders (CVD), diabetic kidney disease (DKD), diabetic retinopathy (DR), diabetic neuropathy (DN), and lower extremity arterial disease (LEAD) was assessed using a qualitative and quantitative analysis. Results Twelve studies were included. The majority of studies were on DKD. Pooled analysis showed that high Lp-PLA2 was associated with significantly higher risk of DKD (OR: 1.01 95% CI: 1.01, 1.02 I 2 = 93%) but not for CVD (OR: 1.11 95% CI: 0.97, 1.26 I 2 = 88%), DN (OR: 2.02 95% CI: 0.40, 10.23 I 2 = 88%) or DR (OR: 1.28 95% CI: 0.49, 3.34 I 2 = 96%). Sensitivity analysis revealed non-significant results for DKD and CVD. Subgroup analysis for DKD showed that heterogeneity reduced to zero in cross-sectional studies, among those with