Elevated lipoprotein(a) triples the hazard of bioprosthetic aortic valve degeneration (J Clin Lipidol 2026)

Background: Structural valve degeneration (SVD) remains a major limitation of bioprosthetic aortic valves (bAVs). Lipoprotein(a) [Lp(a)] is a genetically determined cardiovascular risk factor implicated in native aortic valve calcification, but its role in bioprosthetic valve degeneration remains incompletely understood.

Objective: To systematically evaluate the association between elevated Lp(a) levels and structural degeneration of bAVs.

Methods: A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, EBSCOhost, and Cochrane Library databases were searched for studies evaluating Lp(a) and structural degeneration of bAVs in patients undergoing surgical or transcatheter aortic valve replacement. Random-effects models were used to pool effect estimates. Cross-sectional outcomes were summarized using odds ratios (ORs), and longitudinal outcomes were pooled using hazard ratios (HRs), both with 95% CIs.

Results: Five observational cohort studies, including 1227 patients, were included. In cross-sectional analyses (2 studies), elevated Lp(a) levels were significantly associated with SVD (OR 2.09, 95% CI 1.02-4.28; I² = 0%). In longitudinal analyses (3 studies), elevated Lp(a) was associated with a higher risk of incident SVD or valve-related reintervention (HR 3.49, 95% CI 2.18-5.59; I² = 0%).

Conclusion: Elevated Lp(a) levels are associated with an increased risk of structural degeneration in bAVs. Lp(a) may represent a useful biomarker for identifying patients at higher risk of valve deterioration and may have implications for surveillance strategies and emerging Lp(a)-lowering therapies.