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Aspirin use, lipoprotein(a), and calcific aortic valve disease: the Multi-ethnic Study of Atherosclerosis

Alexander C Razavi1, Harpreet S Bhatia2, Natalie Marrero3

  • 1Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA.

European Heart Journal
|February 20, 2026
PubMed

Insights

Regular aspirin use may lower the risk of aortic valve calcium and stenosis in individuals with high lipoprotein(a) [Lp(a)], but not high LDL cholesterol. Further research is needed to confirm these findings for high Lp(a) populations.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Epidemiology

Background:

  • Lipoprotein(a) [Lp(a)] and LDL cholesterol (LDL-C) are established risk factors for aortic valve calcium (AVC) and aortic stenosis (AS).
  • Lp(a) possesses anti-fibrinolytic properties, suggesting a potential role for aspirin in mitigating cardiovascular disease risk in specific patient groups.
  • Understanding the interplay between aspirin, Lp(a), and LDL-C in AVC/AS development is crucial for targeted prevention strategies.

Purpose of the Study:

  • To investigate the association between regular aspirin use and the incidence of AVC and severe AS.
  • To determine if this association differs based on varying levels of Lipoprotein(a) [Lp(a)] and LDL cholesterol (LDL-C).
  • To explore potential therapeutic benefits of aspirin in individuals with elevated cardiovascular risk markers.

Main Methods:

  • An observational cohort study utilizing data from the Multi-Ethnic Study of Atherosclerosis (up to 6598 participants).
  • Aortic valve calcium (AVC) was quantified using non-contrast cardiac computed tomography.
  • Multivariable Cox hazards regression models analyzed the association of regular aspirin use (≥3 days/week) with incident AVC and severe AS, stratified by Lp(a) and LDL-C levels.

Main Results:

  • Regular aspirin use was associated with a significantly reduced risk of incident AVC and severe AS in individuals with elevated Lp(a) levels.
  • No significant association was observed between regular aspirin use and the risk of incident AVC or severe AS in participants with elevated LDL-C levels.
  • Specific hazard ratios indicated substantial risk reduction for AVC and AS with aspirin in high Lp(a) groups (e.g., HR 0.17 for AVC with Lp(a) ≥100 mg/dL).

Conclusions:

  • Regular aspirin use demonstrates a potential protective effect against AVC and severe AS in individuals with high Lp(a).
  • This association was not evident in individuals with elevated LDL-C, suggesting a differential impact based on lipid profiles.
  • Further confirmatory studies are warranted to establish the definitive role of aspirin in preventing AVC and AS for high Lp(a) populations.
Abstract

Keywords:
Aortic stenosisAortic valve calciumAortic valve diseaseAspirinComputed tomographyLDL cholesterolLipoprotein(a)

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