The standard 30 mg/dL Lp(a) cutoff predicts aortic valve calcification in white and Black adults, but not Hispanics or Chinese, the MESA study of 4678 adults (Arterioscler Thromb Vasc Biol 2016)

Original title: Lipoprotein(a) Levels Are Associated With Subclinical Calcific Aortic Valve Disease in White and Black Individuals: The Multi-Ethnic Study of Atherosclerosis

Arterioscler Thromb Vasc Biol · 3 March 2016 · 7

Cao J, Steffen BT, Budoff M, Post WS, Thanassoulis G, Kestenbaum B, McConnell JP, Warnick R, Guan W, Tsai MY

This Multi-Ethnic Study of Atherosclerosis (MESA) analysis measured Lp(a) and aortic valve calcification (AVC) by CT scan in 4678 participants to test whether standard clinical Lp(a) cutoffs predict subclinical calcific aortic valve disease (CAVD) across races and ethnicities. The conventional 30 mg/dL cutoff was associated with AVC in white participants (relative risk 1.56, 1.24-1.96) and borderline significant in Black participants (relative risk 1.55, 0.98-2.44, P=0.059); white participants with Lp(a) at or above 50 mg/dL had even higher AVC prevalence (relative risk 1.72, 1.36-2.17). Lp(a) was also significantly associated with AVC severity in both white and Black individuals, independent of existing coronary artery calcification, but no significant associations were found in Hispanic or Chinese participants. The findings show standard Lp(a) cutoffs apply to calcific aortic valve disease risk in white and Black populations, but race and ethnicity may need to be considered when selecting appropriate thresholds.

Original abstract

Objective: Lipoprotein(a) [Lp(a)] is a risk factor for calcific aortic valve disease (CAVD) but has not been evaluated across multiple races/ethnicities. This study aimed to determine whether Lp(a) cutoff values used in clinical laboratories to assess risk of cardiovascular disease identify subclinical CAVD and its severity and whether significant relations are observed across race/ethnicity.

Approach And Results: Lp(a) concentrations were measured using a turbidimetric immunoassay, and subclinical CAVD was measured by quantifying aortic valve calcification (AVC) through computed tomographic scanning in 4678 participants of the Multi-Ethnic Study of Atherosclerosis. Relative risk and ordered logistic regression analysis determined cross-sectional associations of Lp(a) with AVC and its severity, respectively. The conventional 30 mg/dL Lp(a) clinical cutoff was associated with AVC in white (relative risk: 1.56; confidence interval: 1.24-1.96) and was borderline significant (P=0.059) in black study participants (relative risk: 1.55; confidence interval: 0.98-2.44). Whites with levels ≥50 mg/dL also showed higher prevalence of AVC (relative risk: 1.72; confidence interval: 1.36-2.17) than those below this level. Significant associations were observed between Lp(a) and degree of AVC in both white and black individuals. The presence of existing coronary artery calcification did not affect these associations of Lp(a) and CAVD. There were no significant findings in Hispanics or Chinese.

Conclusions: Lp(a) cutoff values that are currently used to assess cardiovascular risk seem to be applicable to CAVD, but our results suggest race/ethnicity may be important in cutoff selection. Further studies are warranted to determine whether race/ethnicity influences Lp(a) and risk of CAVD incidence and its progression.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.