ELEVATED lipoprotein(a) (Lp[a]) levels do not significantly influence aortic valve calcification or mortality in patients undergoing transcatheter aortic valve replacement (TAVR), new research has shown.
This study examined the role of Lp(a) in aortic valve calcification (AVC) and its prognostic impact on mortality in elderly patients undergoing TAVR. Elevated Lp(a) is a known risk factor for cardiovascular disease, yet its effects on advanced aortic stenosis (AS) remain unclear. Researchers conducted a retrospective analysis of 454 patients treated at a single clinic, aiming to explore whether Lp(a) levels correlated with calcification or outcomes.
The analysis included patients with an average age of 81 years, 22.5% of whom had Lp(a) levels ≥60 mg/dl. The median calcium volume of the cohort was 894.5 mm², and no significant difference in calcification was observed between patients with elevated and lower Lp(a) levels (p = 0.83). Additionally, elevated Lp(a) was not a predictor of calcium volume. Robust regression analysis identified male gender and mean trans-valvular pressure gradient as the strongest correlates of calcification, but Lp(a) showed no association. Mortality analysis revealed no significant impact of Lp(a) levels on 30-day (p = 0.30) or 40-month (p = 0.60) all-cause mortality.
The findings suggest that Lp(a) has limited influence on calcification or outcomes in advanced AS managed by TAVR. This aligns with evidence that Lp(a) may play a larger role in the early progression of AS rather than its later stages. Clinicians should focus on established risk factors such as patient demographics and haemodynamic parameters when considering prognosis and treatment strategies for AS. Future research should explore the potential role of emerging therapies targeting Lp(a) in mitigating the progression of AS, as well as its utility in early disease stages. These insights underscore the importance of tailoring interventions to the disease’s progression rather than treating Lp(a) as a universal marker in advanced AS.
Katrina Thornber, EMJ
Reference
Bormann J et al. The influence of lipoprotein(a) on aortic valve calcification in patients undergoing transcatheter aortic valve replacement. Clin Res Cardiol. 2024;DOI:10.1007/s00392-024-02587-z.
