Regular aspirin use and lower incidence of aortic valve calcium and severe stenosis in people with high Lp(a): MESA (Razavi et al., EHJ 2026)

Original title: Aspirin use, lipoprotein(a), and calcific aortic valve disease: the Multi-ethnic Study of Atherosclerosis

Eur Heart J · 21 February 2026 · 6

Razavi AC, Bhatia HS, Marrero N, Dzaye O, Post WS, Nasir K, Tsai M, Vaccarino V, Vasan RS, Thanassoulis G, Tsimikas S, Sperling LS et al.

In up to 6,598 MESA participants, regular aspirin use was associated with less incident aortic valve calcium (hazard ratio 0.42 at Lp(a) of 75 mg/dL or more, 0.17 at 100 or more) and less severe aortic stenosis (0.13 at 50 or more, 0.02 at 75 or more), with no such association for high LDL-C. Exploratory, observational, small numbers of events, but coherent with the antifibrinolytic biology and with the ASPREE and MESA coronary findings.

Original abstract

Background And Aims: Lipoprotein(a) [Lp(a)] and LDL cholesterol (LDL-C) are causally linked to aortic valve calcium (AVC) and aortic stenosis (AS). Lipoprotein(a) has anti-fibrinolytic properties; therefore, aspirin may reduce cardiovascular disease risk among individuals with high Lp(a). This analysis sought to determine the association of aspirin with incident AVC and AS across Lp(a) and LDL-C levels.

Methods: This observational study included up to 6598 participants in the Multi-Ethnic Study of Atherosclerosis. Aortic valve calcium was measured on non-contrast cardiac computed tomography. Multivariable Cox hazards regression assessed the association of self-reported regular aspirin use (≥3 days/week) with incident AVC and severe AS, stratified by Lp(a) and LDL-C. Aortic valve calcium and Lp(a) values were not reported to participants.

Results: Mean age was 62 years, 53% were women, 23% reported regular aspirin use, 8% developed AVC (median 8.9 years), and 1% developed severe AS (median 16.7 years). Among individuals with elevated Lp(a), regular aspirin use was associated with a lower risk of incident AVC (Lp(a) ≥75 mg/dL: hazard ratio (HR) .42, 95% confidence interval (CI) .19-.93; Lp(a) ≥100 mg/dL: HR .17, 95% CI .04-.67) and severe AS (Lp(a) ≥50 mg/dL: HR .13, 95% CI: .04-.47; Lp(a) ≥75 mg/dL: HR .02, 95% CI .001-.29). For participants with elevated LDL-C, there was no association of regular aspirin use with incident AVC (LDL-C ≥130 mg/dL: HR 1.02, 95% CI .66-1.58; LDL-C ≥160 mg/dL: HR 1.51, 95% CI .53-4.28) or severe AS (LDL-C ≥100 mg/dL: HR .70, 95% CI .39-1.26; LDL-C ≥130 mg/dL: HR .46, 95% CI .14-1.47).

Conclusions: In this exploratory analysis of prospective observational cohort data, regular aspirin use was associated with a lower risk of AVC and severe AS in persons with high Lp(a), but not high LDL-C. Confirmatory studies are required to determine the role of aspirin in the prevention of AVC and AS for persons with high Lp(a).

Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.