Healio
Healio
October 24, 2013
2 min read
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High Lp(a) levels linked to increased risk for aortic valve stenosis

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Results from a new study have identified stepwise elevations in risk for aortic valve stenosis with increasing lipoprotein(a) levels in the general population.

People with Lp(a) levels >95th percentile (>74 mg/dL) had a nearly threefold increased risk for aortic valve stenosis.

For the study, researchers combined data from the Copenhagen City Heart Study (1991 to 2011; n=10,803) and the Copenhagen General Population Study (2003 to 2011; n=66,877). Participants were followed until the onset of aortic valve stenosis (n=454), death (n=6,632), emigration from Denmark (n=364) or May 2011, whichever came first. Mean follow-up was 5 years; maximum follow-up was 20 years.

According to the results, the higher a person’s Lp(a) level, the higher his or her risk for aortic valve stenosis:

  • HR=1.2 (95% CI, 0.8-1.7) for Lp(a) levels of 4 mg/dL to 15 mg/dL
  • HR=1.6 (95% CI, 1.1-2.4) for Lp(a) levels of 16 mg/dL to 55 mg/dL
  • HR=2 (95% CI, 1.2-3.4) for Lp(a) levels of 56 mg/dL to 74 mg/dL
  • HR=2.9 (95% CI, 1.8-4.9) for Lp(a) levels >74 mg/dL

The researchers also found that Lp(a) levels were elevated in carriers of rs10455872 and rs3798220 minor alleles, and in those who had a low number of KIV-2 repeats (P for trend in all<.001). Those three genotypes explained 41% of the total variation in plasma Lp(a) levels, they wrote.

The results did not change after adjustment for factors such as sex, aortic valve stenosis events resulting in aortic valve replacement and MI.

After conducting an instrumental variable analysis and combining all genotypes, the researchers determined a genetic relative risk for aortic valve stenosis of 1.6 (95% CI, 1.2-2.1) for a 10-fold Lp(a) increase, which was comparable to the HR of 1.4 (95% CI, 1.2-1.7) for a 10-fold increase in Lp(a) plasma levels.

According to the researchers, however, these findings do not prove that elevated Lp(a) levels cause aortic valve stenosis; for that, evidence from clinical trials on the effects of lowering Lp(a) levels is needed.

For more information:

Kamstrup PR. J Am Coll Cardiol. 2013;doi:10.1016/j.jacc.2013.09.038.

Disclosure: Some researchers report financial ties to Fresenius Medical Care, Isis Pharmaceuticals, Omthera and Sanofi-Aventis/Regeneron.

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