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. 2025 Apr;4(4):101662.
doi: 10.1016/j.jacadv.2025.101662. Epub 2025 Mar 21.

Lipoprotein (a) Distribution in Aortic Stenosis Patients: Are Lp(a) Reducing Agents the Ultimate Solution?

Michael-Roy R Durr  1 , Ian G Burwash  2 , Lawrence Lau  2 , Hassan Alfraidi  2 , Andrew Mulloy  2 , Anahita Tavoosi  2 , Dimitri Arangalage  3 , Vincent Chan  4 , Moiz Lakhani  2 , Alwaleed Aljamaan  1 , Graeme Prosperi-Porta  2 , Roja Gauda  2 , Luc Beauchesne  2 , Thierry Mesana  4 , David Messika-Zeitoun  5
Affiliations

Lipoprotein (a) Distribution in Aortic Stenosis Patients: Are Lp(a) Reducing Agents the Ultimate Solution?

Michael-Roy R Durr et al. JACC Adv. 2025 Apr.

Abstract

Background: There is currently no medical therapy that can slow down/stop the progression of aortic stenosis (AS). Novel drugs lowering lipoprotein(a) (Lp[a]), a proinflammatory particle linked to AS development, are currently under evaluation, but the proportion of patients with AS and elevated Lp(a) who might benefit from such therapy is not known.

Objectives: The authors sought to characterize the prevalence of high Lp(a) in patients with AS to determine the role of future Lp(a)-lowering therapies.

Methods: In a nonselected Canadian population of AS patients seen in our specialized valve clinic, we assessed Lp(a) levels. High Lp(a) level was defined as an Lp(a) ≥100 nmol/L as per the Canadian Cardiovascular Society's Lipid Guidelines.

Results: Lp(a) levels were measured in 162 patients (mean age: 75 ± 10 years, 43% female, mean pressure gradient: 29 ± 14 mm Hg). Mean Lp(a) was 69 ± 79 nmol/L (median: 24 nmol/L, IQR: 19-91 nmol/L), and 39 patients (24%) had a high Lp(a) level. There were no differences in the mean Lp(a) or in the proportion of high Lp(a) levels with respect to sex, age, or AS severity (all P > 0.20).

Conclusions: In this cross-sectional series of unselected AS patients followed in a valve clinic, only 1 in every 4 patients had a significantly elevated Lp(a) level. Novel Lp(a)-lowering therapies may have limited applicability to most patients with AS and highlight the need for further research into understanding the pathophysiology of AS and developing medical therapies targeting different pathways.

Keywords: aortic stenosis; lipoprotein (a).

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Conflict of interest statement

Funding support and author disclosures This study was funded by the UOHIAMO AFP Innovations Fund (UOH-20-004). Dr Messika-Zeitoun received a research grant from Edwards Lifesciences and is a consultant for Predisurge. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Distribution of Lipoprotein (a) Levels in Patients With Aortic Stenosis Overall and According to Sex Lp(a) distribution followed a “U” curve in both sexes. Notably, only 24% of patients had an Lp(a) ≥100 nmol/L, and only 21% had a level ≥125 nmol/L. Lp(a) = lipoprotein (a).
Figure 2
Figure 2
Proportion of Patients With High Lipoprotein (a) Levels (≥100 nmol/L) in Overall and According to Sex, Age, and Valve Anatomy In the total population, 24% of patients had high Lp(a). This proportion was comparable across the sex, age, and AS severity of groups. AS = aortic stenosis; Lp(a) = lipoprotein (a).
Figure 3
Figure 3
Correlation Between Lipoprotein (a) Levels and Severity of Aortic Stenosis Assessed Using the Mean Pressure Gradient No correlation was observed between Lp(a) level and severity of aortic stenosis. Lp(a) = lipoprotein (a).
Central Illustration
Central Illustration
Lipoprotein (a) Distribution in Aortic Stenosis Only one-quarter of patients with aortic stenosis presented with high Lp(a). Lp(a) = lipoprotein (a).
See this image and copyright information in PMC

References

    1. Aluru J.S., Barsouk A., Saginala K., Rawla P., Barsouk A. Valvular heart disease epidemiology. Med Sci. 2022;10:32. - PMC - PubMed
    1. Afshar M., Yazdan-Ashoori S., Engert J.C., Thanassoulis G. Drugs for prevention and treatment of aortic stenosis: how close are we? Can J Cardiol. 2021;37:1016–1026. - PubMed
    1. Chan K.L., Teo K., Dumesnil J.G., Ni A., Tam J., ASTRONOMER Investigators Effect of Lipid lowering with rosuvastatin on progression of aortic stenosis: results of the aortic stenosis progression observation: measuring effects of rosuvastatin (ASTRONOMER) trial. Circulation. 2010;121:306–314. - PubMed
    1. Cowell S.J., Newby D.E., Prescott R.J., et al. A randomized trial of intensive lipid-lowering therapy in calcific aortic stenosis. N Engl J Med. 2005;352:2389–2397. - PubMed
    1. Rossebø A.B., Pedersen T.R., Boman K., et al. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med. 2008;359:1343–1356. - PubMed