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Lipoprotein(a) and Body Mass Compound the Risk of Calcific Aortic Valve Disease
Morten Kaltoft1, Anne Langsted1, Shoaib Afzal1
1Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Insights
High levels of lipoprotein(a) and high body mass index significantly increase calcific aortic valve disease risk. Extremely high levels of both factors together confer a 3.5-fold increased risk, highlighting their combined impact.
Area of Science:
- Cardiovascular Medicine
- Genetics
- Epidemiology
Background:
- High plasma lipoprotein(a) is a known causal risk factor for calcific aortic valve disease (CAVD).
- High body mass index (BMI) is also recognized as a causal risk factor for CAVD.
- The combined effect of extremely high levels of both factors on CAVD risk requires further investigation.
Purpose of the Study:
- To test the hypothesis that the risk of CAVD is highest when both plasma lipoprotein(a) and BMI are extremely high.
- To evaluate the association between high lipoprotein(a) and high BMI with the risk of CAVD in a large population study.
Main Methods:
- Utilized data from the Copenhagen General Population Study, including 69,988 individuals recruited between 2003 and 2015.
- Employed multivariable adjusted Cox proportional hazards models to assess the association between lipoprotein(a), BMI, and CAVD risk.
- Analyzed 10-year absolute risks of CAVD across categories of lipoprotein(a) levels, BMI, age, and sex.
Main Results:
- Individuals in the 90th to 100th percentiles for both lipoprotein(a) and BMI had a 3.5-fold increased risk of CAVD compared to those in the lowest percentiles.
- The 10-year absolute risk of CAVD increased with higher lipoprotein(a), BMI, and age, and was higher in men than women.
- For individuals aged 70-79 with BMI ≥30.0 kg/m², 10-year risks ranged from 5% to 14% depending on lipoprotein(a) levels.
Conclusions:
- Extremely high lipoprotein(a) and extremely high BMI synergistically confer a significantly elevated risk of calcific aortic valve disease.
- The 10-year absolute risk of CAVD varies considerably based on combined lipoprotein(a) levels, BMI, age, and sex.
- These findings underscore the importance of managing both lipoprotein(a) and BMI for preventing CAVD.
Background:
High plasma lipoprotein(a) and high body mass index are both causal risk factors for calcific aortic valve disease.
Objectives:
This study sought to test the hypothesis that risk of calcific aortic valve disease is the highest when both plasma lipoprotein(a) and body mass index are extremely high.
Methods:
From the Copenhagen General Population Study, we used information on 69,988 randomly selected individuals recruited from 2003 to 2015 (median follow-up 7.4 years) to evaluate the association between high lipoprotein(a) and high body mass index with risk of calcific aortic valve disease.
Results:
Compared with individuals in the 1st to 49th percentiles for both lipoprotein(a) and body mass index, the multivariable adjusted HRs for calcific aortic valve disease were 1.6 (95% CI: 1.3-1.9) for the 50th to 89th percentiles of both (16% of all individuals) and 3.5 (95% CI: 2.5-5.1) for the 90th to 100th percentiles of both (1.1%) (P for interaction = 0.92). The 10-year absolute risk of calcific aortic valve disease increased with higher lipoprotein(a), body mass index, and age, and was higher in men than in women. For women and men 70-79 years of age with body mass index ≥30.0 kg/m2, 10-year absolute risks were 5% and 8% for lipoprotein(a) ≤42 mg/dL (88 nmol/L), 7% and 11% for 42-79 mg/dL (89-169 nmol/L), and 9% and 14% for lipoprotein(a) ≥80 mg/dL (170 nmol/L), respectively.
Conclusions:
Extremely high lipoprotein(a) levels and extremely high body mass index together conferred a 3.5-fold risk of calcific aortic valve disease. Ten-year absolute risk of calcific aortic valve disease by categories of lipoprotein(a) levels, body mass index, age, and sex ranged from 0.4% to 14%.
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