Impact of Lipoprotein(a) on Valvular and Cardiovascular Outcomes in Patients With Calcific Aortic Valve Stenosis
Background Lp(a) (lipoprotein(a)) is an independent risk factor for calcific aortic valve stenosis (CAVS). Whether patients with CAVS and high Lp(a) levels are at higher risk of valvular or cardiovascular events is unknown. The aim of this study is to determine whether higher Lp(a) levels are associ...
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Wiley
2025-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.038955 |
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| author | Arnaud S. Girard Audrey Paulin Hasanga D. Manikpurage Emma Lajeunesse Marie‐Annick Clavel Philippe Pibarot John H. Krege Patrick Mathieu Sébastien Thériault Benoit J. Arsenault |
| author_facet | Arnaud S. Girard Audrey Paulin Hasanga D. Manikpurage Emma Lajeunesse Marie‐Annick Clavel Philippe Pibarot John H. Krege Patrick Mathieu Sébastien Thériault Benoit J. Arsenault |
| author_sort | Arnaud S. Girard |
| collection | DOAJ |
| description | Background Lp(a) (lipoprotein(a)) is an independent risk factor for calcific aortic valve stenosis (CAVS). Whether patients with CAVS and high Lp(a) levels are at higher risk of valvular or cardiovascular events is unknown. The aim of this study is to determine whether higher Lp(a) levels are associated with valvular and cardiovascular outcomes in patients with CAVS. Methods and Results We identified 1962 patients from the UK Biobank with an electronic health record or self‐reported CAVS diagnosis but who did not previously undergo aortic valve replacement (AVR) and had a minimal follow‐up time of 2.5 years. Cox proportional hazard regression was used to evaluate the effect of Lp(a) on AVR, AVR or cardiac death, and valvular or cardiovascular events (AVR, cardiac death, myocardial infarction, stroke, heart failure, or coronary artery bypass grafting). The maximal follow‐up time was set to 5 years. During the follow‐up, 198 patients underwent AVR, 260 had AVR or cardiac death, and 435 had at least 1 valvular or cardiovascular event. Patients with Lp(a) levels ≥125 versus <125 nmol/L were at higher risk of AVR (hazard ratio [HR], 1.58 [95% CI, 1.17–2.12]), AVR or cardiac death (HR, 1.43 [95% CI, 1.10–1.86]), and cardiovascular or valvular events (HR, 1.36 [95% CI, 1.11–1.68]). Point estimates were comparable in men versus women, younger versus older patients, and in patients with higher versus lower plasma C‐reactive protein levels. Conclusions In patients with CAVS, Lp(a) levels predicted a higher risk of valvular and cardiovascular outcomes. The impact of Lp(a)‐lowering therapies on valvular and cardiovascular health should be assessed in a long‐term randomized clinical trial. |
| format | Article |
| id | doaj-art-b02cf572231f448d85bda7d7f11ec9d8 |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-b02cf572231f448d85bda7d7f11ec9d82025-08-20T02:03:19ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-03-0114610.1161/JAHA.124.038955Impact of Lipoprotein(a) on Valvular and Cardiovascular Outcomes in Patients With Calcific Aortic Valve StenosisArnaud S. Girard0Audrey Paulin1Hasanga D. Manikpurage2Emma Lajeunesse3Marie‐Annick Clavel4Philippe Pibarot5John H. Krege6Patrick Mathieu7Sébastien Thériault8Benoit J. Arsenault9Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec‐Université Laval Québec QC CanadaCentre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec‐Université Laval Québec QC CanadaCentre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec‐Université Laval Québec QC CanadaCentre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec‐Université Laval Québec QC CanadaCentre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec‐Université Laval Québec QC CanadaCentre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec‐Université Laval Québec QC CanadaEli Lilly Indianapolis IN USACentre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec‐Université Laval Québec QC CanadaCentre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec‐Université Laval Québec QC CanadaCentre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec‐Université Laval Québec QC CanadaBackground Lp(a) (lipoprotein(a)) is an independent risk factor for calcific aortic valve stenosis (CAVS). Whether patients with CAVS and high Lp(a) levels are at higher risk of valvular or cardiovascular events is unknown. The aim of this study is to determine whether higher Lp(a) levels are associated with valvular and cardiovascular outcomes in patients with CAVS. Methods and Results We identified 1962 patients from the UK Biobank with an electronic health record or self‐reported CAVS diagnosis but who did not previously undergo aortic valve replacement (AVR) and had a minimal follow‐up time of 2.5 years. Cox proportional hazard regression was used to evaluate the effect of Lp(a) on AVR, AVR or cardiac death, and valvular or cardiovascular events (AVR, cardiac death, myocardial infarction, stroke, heart failure, or coronary artery bypass grafting). The maximal follow‐up time was set to 5 years. During the follow‐up, 198 patients underwent AVR, 260 had AVR or cardiac death, and 435 had at least 1 valvular or cardiovascular event. Patients with Lp(a) levels ≥125 versus <125 nmol/L were at higher risk of AVR (hazard ratio [HR], 1.58 [95% CI, 1.17–2.12]), AVR or cardiac death (HR, 1.43 [95% CI, 1.10–1.86]), and cardiovascular or valvular events (HR, 1.36 [95% CI, 1.11–1.68]). Point estimates were comparable in men versus women, younger versus older patients, and in patients with higher versus lower plasma C‐reactive protein levels. Conclusions In patients with CAVS, Lp(a) levels predicted a higher risk of valvular and cardiovascular outcomes. The impact of Lp(a)‐lowering therapies on valvular and cardiovascular health should be assessed in a long‐term randomized clinical trial.https://www.ahajournals.org/doi/10.1161/JAHA.124.038955aortic valve replacementcalcific aortic valve stenosisheart failurelipoprotein(a)myocardial infarctionstroke |
| spellingShingle | Arnaud S. Girard Audrey Paulin Hasanga D. Manikpurage Emma Lajeunesse Marie‐Annick Clavel Philippe Pibarot John H. Krege Patrick Mathieu Sébastien Thériault Benoit J. Arsenault Impact of Lipoprotein(a) on Valvular and Cardiovascular Outcomes in Patients With Calcific Aortic Valve Stenosis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic valve replacement calcific aortic valve stenosis heart failure lipoprotein(a) myocardial infarction stroke |
| title | Impact of Lipoprotein(a) on Valvular and Cardiovascular Outcomes in Patients With Calcific Aortic Valve Stenosis |
| title_full | Impact of Lipoprotein(a) on Valvular and Cardiovascular Outcomes in Patients With Calcific Aortic Valve Stenosis |
| title_fullStr | Impact of Lipoprotein(a) on Valvular and Cardiovascular Outcomes in Patients With Calcific Aortic Valve Stenosis |
| title_full_unstemmed | Impact of Lipoprotein(a) on Valvular and Cardiovascular Outcomes in Patients With Calcific Aortic Valve Stenosis |
| title_short | Impact of Lipoprotein(a) on Valvular and Cardiovascular Outcomes in Patients With Calcific Aortic Valve Stenosis |
| title_sort | impact of lipoprotein a on valvular and cardiovascular outcomes in patients with calcific aortic valve stenosis |
| topic | aortic valve replacement calcific aortic valve stenosis heart failure lipoprotein(a) myocardial infarction stroke |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.038955 |
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