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Lipoprotein(a) and Calcific Aortic Valve Stenosis Progression: A Systematic Review and Meta-Analysis
Benoit J Arsenault1,2, Krithika Loganath3, Arnaud Girard1
1Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada.
Higher plasma lipoprotein(a) levels accelerate aortic stenosis progression. This finding suggests that targeting lipoprotein(a) may offer a new treatment strategy for aortic stenosis patients.
Area of Science:
- Cardiovascular Medicine
- Clinical Research
- Biomarkers
Background:
- Aortic stenosis (AS) lacks pharmacological treatments to slow hemodynamic progression.
- Plasma lipoprotein(a) [Lp(a)] predicts AS incidence, but its role in AS progression is debated.
Purpose of the Study:
- To investigate the association between plasma Lp(a) concentrations and the rate of hemodynamic progression in patients with AS.
Main Methods:
- Analysis of data from 710 patients with AS across 5 longitudinal studies in Canada and the UK (2001-2023).
- Assessment of hemodynamic progression via echocardiography, measuring annualized changes in peak aortic jet velocity, mean transvalvular gradient, and aortic valve area.
- Stratification of patients into Lp(a) concentration tertiles for comparative analysis.
Main Results:
- Patients in the highest Lp(a) tertile showed significantly faster progression in peak aortic jet velocity (41% faster) and mean transvalvular gradient (57% faster) compared to the lowest tertile.
- No significant difference in aortic valve area progression was observed between Lp(a) groups.
- Results remained consistent when Lp(a) was analyzed as a continuous variable.
Conclusions:
- Elevated plasma Lp(a) concentrations are associated with accelerated hemodynamic progression of aortic stenosis.
- Targeting Lp(a) may represent a potential therapeutic avenue for preventing or slowing AS progression, warranting further investigation.
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