Netherlands: Lipoprotein(a) is robustly associated with the development of aortic valve calcification (AVC) but not with the progression of calcification over long-term follow-up, says a recent study. The study, published in European Heart Journal, suggests the Lp(a)-lowering interventions may be most effective prior to the onset of calcification.
Lp(a) is a potential factor in the pathogenesis of aortic valve disease. However, no study has been done on the relationship of Lp(a) with new-onset and progression of aortic valve calcium. To fill this knowledge gap, Daniel Bos, Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands, and colleagues aimed to assess whether high serum levels of Lp(a) are associated with AVC incidence and progression.

For this purpose, a total of 922 individuals from the population-based Rotterdam Study (mean age 66.0±4.2 years, 47.7% men underwent non-enhanced cardiac computed tomography imaging at baseline and after a median follow-up of 14.0 years. Their Lp(a) measurements were available. New-onset AVC was defined as an AVC score >0 on the follow-up scan in the AVC absence on the first scan.
Progression was defined as the absolute difference in AVC score between the baseline and follow-up scan. To evaluate the relationship of Lp(a) with baseline, new onset, and progression of AVC, logistic and linear regression analyses were performed. All analyses were corrected for age, body mass index, sex, dyslipidemia, hypertension, and creatinine.
Based on the study, the researchers reported the following:
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, the median annual progression was 13.5 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)] and new-onset AVC (OR 1.30 for each 50 mg/dL higher Lp(a)), but not with AVC progression (β: −71 AU for each 50 mg/dL higher Lp(a)).
Only baseline AVC score was significantly associated with AVC progression.
"In the population-based Rotterdam Study, Lp(a) was associated with the onset of AVC in multivariable analysis after adjusting for body mass index, sex, age, smoking, hypertension, dyslipidemia, and creatinine," the researchers wrote. "In contrast, AVC progression was only associated with baseline AVC score. This implies that disease progression may take place independent of initiating risk factors."
Reference:
Yannick Kaiser, Janine E van der Toorn, Sunny S Singh, Kang H Zheng, Maryam Kavousi, Eric J G Sijbrands, Erik S G Stroes, Meike W Vernooij, Yolanda B de Rijke, S Matthijs Boekholdt, Daniel Bos, Lipoprotein(a) is associated with the onset but not the progression of aortic valve calcification, European Heart Journal, 2022;, ehac377, https://doi.org/10.1093/eurheartj/ehac377