Lp(a) predicts aortic valve calcium in Whites and Blacks but not South Asians, despite South Asians having higher Lp(a) than Whites, in MASALA and MESA (Atherosclerosis 2020)

Original title: Lipoprotein (a) and aortic valve calcium in South Asians compared to other race/ethnic groups

Atherosclerosis · 18 September 2020 · 7

Makshood M, Joshi PH, Kanaya AM, Ayers C, Budoff M, Tsai MY, Blaha M, Michos ED, Post WS

Comparing 695 South Asian participants in the MASALA study with 4,671 participants across four race/ethnic groups in MESA, South Asians had higher median Lp(a) (17.0 mg/dL) than Whites (12.9 mg/dL), Hispanics (13.1 mg/dL) and Chinese Americans (12.9 mg/dL), while Black participants had the highest levels overall (35.1 mg/dL). Aortic valve calcium (AVC) odds did not differ between South Asians and Whites or Hispanics (P=0.64 and 0.63 respectively) after age and sex adjustment, but were lower in Chinese Americans (OR 0.35, 95% CI 0.23-0.54) and somewhat lower in Black participants (OR 0.76, 95% CI 0.56-1.04) compared with South Asians. Lp(a) was associated with AVC presence and extent in Whites and Blacks, but showed no association in South Asians despite their higher Lp(a) levels. The findings suggest race-specific factors may modify how Lp(a) contributes to aortic valve calcification.

Original abstract

Background And Aims: South Asians are at increased risk for cardiovascular disease (CVD). Aortic valve calcium (AVC) is associated with CVD risk and aortic stenosis. Elevated Lp(a) is a heritable risk factor for CVD and AVC. AVC prevalence and its association with Lp(a) have not been studied in South Asians.

Methods: Among participants in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study (n = 695), AVC prevalence and extent were compared to four race/ethnic groups in the Multi-Ethnic Study of Atherosclerosis (MESA) (n = 4671). Multivariable regression was performed to evaluate associations between Lp(a) and AVC stratified by race/ethnic groups, adjusting for cardiovascular risk factors.

Results: After age and sex adjustment, South Asians had higher median Lp(a) (17.0 mg/dL) compared to Whites (12.9 mg/dL), Hispanics (13.1 mg/dL) and Chinese Americans (12.9 mg/dL), and Blacks had highest Lp(a) levels (35.1 mg/dL). There were no differences in the odds of AVC in South Asians compared with Whites or Hispanics, after age and sex adjustment (p = 0.64 and 0.63, respectively). Odds of AVC was lower in Chinese (OR 0.35; 95%CI 0.23-0.54) and somewhat lower in Blacks compared with South Asians (OR 0.76; 0.56-1.04). There were no associations between Lp(a) and AVC presence or extent in South Asians. Lp(a) was associated with AVC only among Blacks and Whites.

Conclusions: Although present in Whites and Blacks, there were no associations between Lp(a) and AVC in South Asians. These differences may be due to statistic power or race specific modifying factors that influences the effect of Lp(a) particles on AVC pathogenesis.

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