Lipoprotein(a) and aortic stenosis: Practical insights

Abstract

Aims: The role of Lp(a) in cardiovascular diseases is increasingly recognized, with high Lp(a) levels shown to be associated with worse outcomes. In this review, we aim to summarize the literature and the current research status regarding AS and Lp(a) with a comprehensive approach, in order to inform basic and clinical scientists with the most up-to-date data and insights.

Data synthesis: Lp(a) is significantly involved in the pathogenesis of aortic stenosis (AS), with the interplay between AS and Lp(a) being documented in observational studies and a causal association being proposed based on genetic studies. Patients with AS have generally higher levels of Lp(a) and increased Lp(a) levels are associated with higher risk of AS development. The above observations offer opportunities for further research, mainly regarding potential therapeutic implications, particularly considering the Lp(a)-specific lowering therapies that are awaited to influence the prevention and treatment strategies for AS.

Conclusion: Increased Lp(a) levels can be predictive of the presence, development and progression of AS, as well as could offer novel insights in the pathophysiology of bioprosthetic valve function. Further research, focusing on Lp(a)-lowering agents, is key in order to identify any benefit in such patient phenotypes.

Keywords: Aortic stenosis; Aortic valve replacement; Lp(a); Transcatheter aortic valve implantation; lipoprotein(a).