Plasma Lipoprotein(a) measured in routine clinical care and the association with incident calcified aortic valve stenosis during a 14-year observational period

Abstract

Background and aimsLipoprotein(a) [Lp(a)] is a causal cardiovascular risk factor recommended to be measured at least once in a lifetime. We aimed to establish the association between routinely measured Lp(a) levels and the development of incident calcified aortic valve stenosis (CAVS). MethodsThis retrospective registry based observational study includes all individuals who had their Lp(a) measured in clinical routine between 2003 and 2017 at Karolinska University Laboratory, Stockholm. Data on pre-existing medical conditions, pharmacological treatment and outcomes were retrieved from national patient registries. ResultsThe study comprised 23,298 individuals of which 489 received a CAVS diagnosis during the study period. The CAVS group (71 ± 11 years, 62% males) had a larger cardiovascular burden than the group without CAVS (55 ± 17 years and 48% males). Individuals with CAVS had higher Lp(a) 90th percentile (117 mg/dL or 249 nmol/L) than those without (89 mg/dL or 179 nmol/L) (p < 0.001), a difference seen in both sexes. The incident rates of CAVS per 10,000 person-years was 22.3 for individuals at >90th Lp(a) percentile compared to 12.8 for the 0th – 50th percentiles (p < 0.001). Sex and age adjusted hazard ratios for development of incident CAVS was 1.53 (95% CI 1.08–2.15; p = 0.016) and for surgical or endovascular intervention for CAVS 1.42 (95% CI 0.73–2.79; p = 0.304) for individuals at Lp(a) > 90th percentile compared to the 0th – 50th percentile. ConclusionsLp(a) measured in the clinical routine is higher in individuals with CAVS. An Lp(a) level above >90th percentile is associated with the development of incident CAVS during a 14-year observational period.