Aortic stenosis
Lp(a) above 100 mg/dL nearly doubles risk of severe degenerative aortic stenosis, but not bicuspid or rheumatic disease, in 44,742 patients (JACC Asia 2024)
Original title: Association of Lipoprotein(a) With Severe Degenerative Aortic Valve Stenosis
In 44,742 patients with Lp(a) measurements and baseline echocardiography at a single tertiary heart centre between 2000 and 2020, followed for a median 6.8 years, severe degenerative aortic stenosis developed in 472 patients (1.1%) and 387 (0.9%) underwent subsequent aortic valve replacement (AVR). Compared with Lp(a) below 30 mg/dL, adjusted hazard ratios for severe degenerative aortic stenosis were 1.02 (30-50 mg/dL), 1.18 (50-100 mg/dL), and 1.96 (above 100 mg/dL, 95% CI 1.31-2.94, P = 0.001). Lp(a) above 100 mg/dL was similarly associated with AVR for degenerative disease (adjusted hazard ratio 2.05, 95% CI 1.31-3.19, P = 0.002). No such association was found for bicuspid or rheumatic aortic stenosis. Elevated Lp(a) specifically predicts degenerative, not bicuspid or rheumatic, severe aortic stenosis and its need for valve replacement, pointing to a distinct pathogenic role in the calcific degenerative process.
Original abstract
Background: Lipoprotein(a) (Lp[a]) is associated with the development of aortic valve calcification.
Objectives: The aim of this study was to evaluate the association between the serum level of Lp(a) and the development of severe degenerative aortic stenosis (AS) and subsequent aortic valve replacement (AVR).
Methods: A total of 44,742 patients with Lp(a) measurements and echocardiography at baseline evaluation between 2000 and 2020 were included from a single tertiary heart center. The primary outcome was the development of severe degenerative AS, defined as a transaortic maximal velocity of ≥4.0 m/s.
Results: During a median follow-up period of 6.8 years (Q1-Q3: 2.3-12.4 years), severe degenerative AS was diagnosed in 472 patients (1.1%), and subsequent AVR was performed in 387 patients (0.9%). Lp(a) levels were associated with risk for severe degenerative AS, with levels of 30 to 50, 50 to 100, and >100 mg/dL demonstrating adjusted HRs of 1.02 (95% CI: 0.78-1.34; P = 0.88), 1.18 (95% CI: 0.91-1.53; P = 0.22), and 1.96 (95% CI: 1.31-2.94; P = 0.001) compared to <30 mg/dL. Similarly, the risk for AVR due to severe degenerative AS was significantly associated with higher levels of Lp(a) (>100 mg/dL) (adjusted HR: 2.05; 95% CI: 1.31-3.19; P = 0.002). Such associations were not observed in the development of severe bicuspid (P = 0.63) or rheumatic (P = 0.96) AS.
Conclusions: Lp(a) levels >100 mg/dL were significantly associated with risk for severe degenerative AS and subsequent AVR, regardless of the baseline severity of AS. Such associations were not observed in other etiologies of severe AS.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.