Aortic stenosis
High lipoprotein(a) predicts bioprosthetic aortic valve degeneration in 210 patients (Heart 2024)
Original title: Role of lipoprotein(a) concentrations in bioprosthetic aortic valve degeneration
In a retrospective multicentre study of 210 patients who underwent bioprosthetic aortic valve replacement between 2010 and 2020, bioprosthetic valve degeneration occurred in 33 patients (15.7%) over a median 4.4-year echocardiographic follow-up. Median Lp(a) was higher in patients with degeneration than without (50.0 vs 15.6 mg/dL, P=0.002). High Lp(a) (>=30 mg/dL) was associated with degeneration in both univariable (HR 3.6, 95% CI 1.7-7.6, P=0.001) and multivariable analysis (HR 4.4, 95% CI 1.9-10.4, P=0.001). The findings extend the Lp(a)-calcific valve disease link to bioprosthetic valves and raise the question of whether Lp(a)-lowering could slow bioprosthesis degeneration, which prospective studies must confirm.
Original abstract
Objectives: Lipoprotein(a) (Lp(a)) is associated with an increased incidence of native aortic stenosis, which shares similar pathological mechanisms with bioprosthetic aortic valve (bAV) degeneration. However, evidence regarding the role of Lp(a) concentrations in bAV degeneration is lacking. This study aims to evaluate the association between Lp(a) concentrations and bAV degeneration.
Methods: In this retrospective multicentre study, patients who underwent a bAV replacement between 1 January 2010 and 31 December 2020 and had a Lp(a) measurement were included. Echocardiography follow-up was performed to determine the presence of bioprosthetic valve degeneration, which was defined as an increase >10 mm Hg in mean gradient from baseline with concomitant decrease in effective orifice area and Doppler Velocity Index, or new moderate/severe prosthetic regurgitation. Levels of Lp(a) were compared between patients with and without degeneration and Cox regression analysis was performed to investigate the association between Lp(a) levels and bioprosthetic valve degeneration.
Results: In total, 210 cases were included (mean age 74.1±9.4 years, 72.4% males). Median time between baseline and follow-up echocardiography was 4.4 (IQR 3.7) years. Bioprostheses degeneration was observed in 33 (15.7%) patients at follow-up. Median serum levels of Lp(a) were significantly higher in patients affected by degeneration versus non-affected cases: 50.0 (IQR 72.0) vs 15.6 (IQR 48.6) mg/dL, p=0.002. In the regression analysis, high Lp(a) levels (≥30 mg/dL) were associated with degeneration both in a univariable analysis (HR 3.6, 95% CI 1.7 to 7.6, p=0.001) and multivariable analysis adjusted by other risk factors for bioprostheses degeneration (HR 4.4, 95% CI 1.9 to 10.4, p=0.001).
Conclusions: High serum Lp(a) is associated with bAV degeneration. Prospective studies are needed to confirm these findings and to investigate whether lowering Lp(a) levels could slow bioprostheses degradation.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.