Journal of the American College of Cardiology (JACC)Lp(a) and Calcific Aortic Valve Stenosis Progression

Elevated Lp(a) Linked to Faster Aortic Stenosis Progression: Potential Therapeutic Target Identified

A comprehensive study spanning five longitudinal clinical trials from 2001 to 2023 has revealed a significant association between elevated plasma lipoprotein(a) [Lp(a)] concentrations and accelerated hemodynamic progression in patients with aortic stenosis. The research, involving 710 patients from Canada and the United Kingdom, provides compelling evidence that Lp(a) may be a crucial factor in the progression of this cardiovascular condition, potentially opening new avenues for therapeutic intervention.

Key Points:

• The study included 710 patients with aortic stenosis, with 70% male and 30% female participants.
• Mean age of participants was 65.2 years (standard deviation: 13.1 years).
• Patients in the top Lp(a) tertile showed 41% faster progression of peak aortic jet velocity compared to those in the bottom tertile.
• Mean transvalvular gradient progression was 57% faster in the top Lp(a) tertile compared to the bottom tertile.
• No significant difference was observed in aortic valve area progression between Lp(a) tertiles.
• Results were consistent when Lp(a) concentrations were analyzed as a continuous variable.
• The association between Lp(a) and faster progression was consistent across all five cohorts studied.
• Elevated Lp(a) is linked to both incident aortic stenosis and more rapid hemodynamic progression.
• The study suggests Lp(a) as a potential therapeutic target for aortic stenosis.
• Further research is needed to establish causality and explore the effects of Lp(a) lowering on aortic stenosis progression.

Contrary to previous suggestions of steep threshold effects, an analysis of 126,634 individuals has demonstrated broadly continuous associations of Lp(a) concentration with the risk of CHD. (JAMA)

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