Lipoprotein(a) is robustly associated with aortic valve calcium

Kaiser, Yannick; Singh, Sunny S; Zheng, Kang; Verbeek, Rutger; Kavousi, Maryam; Pinto, Sara-Joan; Vernooij, Meike W.; Sijbrands, Eric; Boekholdt, S. Matthijs; Rijke, Yolanda B. de; Stroes, Erik S.G.; Bos, Daniël

doi:10.1136/heartjnl-2021-319044

Cited by 39 publications

(29 citation statements)

References 25 publications

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“…We have previously shown that approximately one in five individuals with Lp(a) >50 mg/dL develop AVC between 50 and 60 years. 22 The recommendation by the 2019 ESC/EAS dyslipidaemia guidelines to measure Lp(a) at least once in each person’s lifetime would facilitate selection of these high-risk individuals. 23 Delaying the onset of AVC may be able to prevent end-stage AVS from occurring in these individuals, supported by our observation that not a single participant without AVC on the first scan underwent AVR during 14 years of follow-up.…”

Section: Discussionmentioning

confidence: 99%

Lipoprotein(a) is associated with the onset but not the progression of aortic valve calcification

Kaiser

Toorn

Singh

et al. 2022

European Heart Journal

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Aim Lipoprotein(a) [Lp(a)] is a potential causal factor in the pathogenesis of aortic valve disease. However, the relationship of Lp(a) with new onset and progression of aortic valve calcium (AVC) has not been studied. The purpose of the study was to assess whether high serum levels of Lp(a) are associated with AVC incidence and progression. Methods and results A total of 922 individuals from the population-based Rotterdam Study (mean age 66.0±4.2 years, 47.7% men), whose Lp(a) measurements were available, underwent non-enhanced cardiac computed tomography imaging at baseline and after a median follow-up of 14.0 [interquartile range (IQR) 13.9–14.2] years. New-onset AVC was defined as an AVC score >0 on the follow-up scan in the absence of AVC on the first scan. Progression was defined as the absolute difference in AVC score between the baseline and follow-up scan. Logistic and linear regression analyses were performed to evaluate the relationship of Lp(a) with baseline, new onset, and progression of AVC. All analyses were corrected for age, sex, body mass index, smoking, hypertension, dyslipidaemia, and creatinine. AVC progression was analysed conditional on baseline AVC score expressed as restricted cubic splines. Of the 702 individuals without AVC at baseline, 415 (59.1%) developed new-onset AVC on the follow-up scan. In those with baseline AVC, median annual progression was 13.5 (IQR = 5.2–37.8) Agatston units (AU). Lipoprotein(a) concentration was independently associated with baseline AVC [odds ratio (OR) 1.43 for each 50 mg/dL higher Lp(a); 95% confidence interval (CI) 1.15–1.79] and new-onset AVC (OR 1.30 for each 50 mg/dL higher Lp(a); 95% CI 1.02–1.65), but not with AVC progression (β: −71 AU for each 50 mg/dL higher Lp(a); 95% CI −117; 35). Only baseline AVC score was significantly associated with AVC progression (P < 0.001). Conclusion In the population-based Rotterdam Study, Lp(a) is robustly associated with baseline and new-onset AVC but not with AVC progression, suggesting that Lp(a)-lowering interventions may be most effective in pre-calcific stages of aortic valve disease.

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Section: Discussionmentioning

confidence: 99%

Lipoprotein(a) is associated with the onset but not the progression of aortic valve calcification

Kaiser

Toorn

Singh

et al. 2022

European Heart Journal

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“…Многочисленные исследования показали, что повышенные уровни Лп(а) ассоциированы с ранним развитием атеросклероза и преждевременных ССЗ [32][33][34][35]. Так, в исследовании Лп(а) у пациентов с ранней манифестацией ОКС повышенные концентрации частицы выявлялись в 41% случаев по сравнению с 14% в контрольной группе, уровень >30 мг/дл был независимо связан с развитием ОКС, а уровень Лп(а) выше 15 мг/дл ассоциировался с поражением коронарных артерий из разных бассейнов [35].…”

Section: материал и методыunclassified

New opportunities for identifying the risk of cardiovascular events in young people: the role of familial hypercholesterolemia

et al. 2023

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A search was made for publications on modern methods for determining cardiovascular risk in young people with positive family history for early cardiovascular events. The use of various screening options allows timely identification of patients with heterozygous familial hypercholesterolemia who have a high cardiovascular risk. The most effective method is cascade screening. Cardiovascular risk assessment systems that include a family history of early cardiovascular events and lipid profiles in individuals under 40 years of age provide prevention of atherosclerosis. In the diagnosis of risk, the lipoprotein (a) is of particular clinical importance, elevated concentrations of which are associated with a high risk of vascular damage and an unfavorable course of atherosclerosis.

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“…The study of Kaiser et al showed that individuals with elevated Lp (a) levels have a significantly increased prevalence of AVC, independently from age, sex, BMI, smoking, use of antihypertensive medication, and non-high-density lipoprotein cholesterol serum levels. Moreover, they found that additional adjustment for a sensitive parameter such as the coronary artery calcium, which reflects the global atherosclerotic burden, did not alter in any way the strong relationship between Lp (a) and AVC [37].…”

Section: Comparison Between Lp (A) and Other Risk Factors For Aortic ...mentioning

confidence: 99%

Perspective Chapter: Lipoprotein (a), Cardiac Amyloidosis, and Aortic Stenosis - Underestimated Associations

Santangelo¹,

Bernardi²,

Faggiano³

et al. 2022

Aortic Stenosis - Recent Advances, New Perspectives and Applications

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This chapter aims to address two peculiar aspects of pathophysiology and clinical management of aortic valve stenosis, such as coexistence with cardiac amyloidosis and association with lipoprotein (a). Calcific aortic valve stenosis is the most common heart valve condition requiring surgical or transcatheter aortic valve replacement among adults in Western societies. Lipoprotein (a) has been shown to play an important role in the pathophysiological pathways leading to degenerative aortic stenosis, similar to that in the pathogenesis of atherosclerosis. Studies are needed to verify whether therapies that drastically reduce Lipoprotein (a) serum levels offer the possibility of a first medical treatment to arrest the progression of aortic stenosis. A large percentage of patients with aortic stenosis may have concomitant cardiac amyloidosis, commonly due to wild-type transthyretin. The challenge in this context is to differentiate aortic stenosis alone from aortic stenosis with cardiac amyloidosis, as cardiac amyloidosis shares several clinical, electrocardiographic, and echocardiographic features with the aortic stenosis phenotype. Recognition of transthyretin-related amyloidosis prior to any type of intervention is crucial for adequate risk stratification and to guide downstream management.

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Lipoprotein(a) is robustly associated with aortic valve calcium

Cited by 39 publications

References 25 publications

Lipoprotein(a) is associated with the onset but not the progression of aortic valve calcification

Lipoprotein(a) is associated with the onset but not the progression of aortic valve calcification

New opportunities for identifying the risk of cardiovascular events in young people: the role of familial hypercholesterolemia

Perspective Chapter: Lipoprotein (a), Cardiac Amyloidosis, and Aortic Stenosis - Underestimated Associations

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