Abstract
Lipoproteins are associated with acquired aortic valve stenosis (AS). This study investigated whether an elevated apolipoprotein (apo)B/apoA-1 ratio was associated with an increased risk of AS and if this association was influenced by a history of a major adverse cardiovascular event (MACE) defined as stroke, myocardial infarction or revascularisation. A study was undertaken of 131,816 individuals, aged ≥30 years, from the Swedish Apolipoprotein MOrtality RISk (AMORIS) cohort, with measurements of apolipoproteins B and A-1 at health examinations during 1985-1996. There were fewer women and the average age was 4 years older in the highest apoB/apoA-1 quintile compared with the lowest. Being overweight, having reduced renal function and diabetes mellitus were more frequent. Low-density lipoprotein cholesterol, triglyceride and apolipoprotein B levels were higher in the top apoB/apoA-1 quintile. During follow-up through 2011, non-rheumatic aortic valve disease was diagnosed in 2,999 individuals (2.3%). Using ICD-10 codes from 1997, AS was identified in 1,887 patients. An elevated apoB/apoA-1 ratio was associated with an increased incidence of aortic valve disease after multivariable adjustment [hazard ratio (HR) (95% CI) for the fifth vs first quintile of 1.28 (1.09-1.50)]. Restricting the analyses to incident AS during 1997-2011 yielded an HR of 1.41 (1.15-1.72). This increased incidence was primarily seen in women and individuals aged ≥65 years. History of MACE did not influence these associations. An elevated apoB/apoA-1 ratio was associated with an increased incidence of AS, particularly in women and individuals aged ≥65 years, regardless of previous MACE.
Highlights
Aortic valve stenosis (AS) is the most common valve disease in developed countries, with a prevalence of .10% in people aged .75 years [1]
Lipoproteins are associated with acquired aortic valve stenosis (AS)
This study investigated whether an elevated apolipoproteinB/apoA-1 ratio was associated with an increased risk of AS and if this association was influenced by a history of a major adverse cardiovascular event (MACE) defined as stroke, myocardial infarction or revascularisation
Summary
Aortic valve stenosis (AS) is the most common valve disease in developed countries, with a prevalence of .10% in people aged .75 years [1]. Elevated lipoprotein (a) was an independent risk factor for AS, while the apoB/ apoA-1 ratio was associated with an increased risk of AS in younger female participants without concomitant coronary artery disease [5]. In Swedish subjects followed for 11 years, increased lipoprotein (a) level and elevated apoB/apoA-1 ratio were associated with surgery for AS in those with concomitant coronary artery disease [10]. A high apoB/ apoA-1 ratio has been reported in patients with degenerated aortic bioprosthesis [12]. These previous studies suggest an important role of dyslipidaemia in the aetiology of AS; further large long-term prospective studies are needed to provide granularity to this association and clarify if other cardiovascular manifestations impact this association.
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