*For medical professionals only
“img class=”responsive ” sizes=”(min-width: 320px) 320px, 100vw” src=”https://mmbiz.qpic.cn/mmbiz_png/x5F5KAyDKw19I4VvcibrfNia7lD1fial5KribXqZxjxMxtoc3ichKKz6ib3w5kJias8QNRBYGn80MM0AxEgOvRLib>p>width=”6400″ >Calcific aortic valve disease (CAVD) is the most common heart valve disease in developed countries and will eventually develop aortic stenosis. As life expectancy increases, the disease burden is expected to increase further.
A high level of plasma lipoprotein(a) is a genetically determined risk factor for aortic stenosis. There are currently no approved drug treatments to lower lipoprotein(a) levels. But there are ongoing randomized clinical trials of several different lipoprotein(a) lowering drugs focused on preventing atherosclerotic cardiovascular disease, not CAVD.
Currently, a high body mass index (BMI) has emerged as an additional risk factor for CAVD. Worldwide, the increasing prevalence of high BMI may contribute to a higher burden of CAVD. Whether high BMI infers a similar, lower, or higher risk of CAVD compared with high plasma lipoprotein(a) is unclear. Furthermore, does the combination of extremely high plasma lipoprotein(a) + extremely high BMI identify individuals at very high risk for CAVD and, in individuals with both high plasma lipoprotein(a) and BMI, the absolute risk of CAVD How high is unclear.
Recently, JACC published a study that attempted to test the hypothesis that when both plasma lipoprotein(a) and body mass index are high, calcific aortic valve disease 10-year absolute risk of CAVD was estimated by lipoprotein(a), BMI, age, and sex. Let’s take a look together!
Research Methods
From Copenhagen In the generalpopulation study,included69,988 randomly selected individuals recruited from 2003 to 2015 participants (median follow-up7.4 years), assessed for high lipoprotein (a)and the association between high body mass index and calcificationgenicaortic valve disease risk Relevance.
Study Results
Multivariate Adjusted Main HR for valve calcification disease:
Compared with individuals in the 1-49th percentile for both lipoprotein(a) and body mass index, p>
Individuals with both in the 50th-89th percentile (16% of all individuals) was 1.6 (95%CI: 1.3-1.9),
< p> Those in the 90th-100th percentile for both (1.1% of all individuals) were 3.5 (95% CI: 2.5-5.1).
(Figure 1 Lipid aortic valve disease risk by classification
with lipoprotein(a), body mass index and age
the 10-year absolute risk of calcified aortic valve disease increased, higher in men than in women.
For people aged 70-79 with a body mass index ≥ 30.0kg/m2, p>
10-year absolute risk levels of lipoprotein(a) for women and men:
≤42mg/dL (88nmol/L): 5% vs. 8%;
42-79mg/dL (89-169nmol/L): 7% vs. 11%;
< p>≥80mg/dL (170nmol/L): 9% vs. 14%.
Figure 3 Additional risk of calcified aortic valve disease due to high lipoprotein(a) and high BMI
Conclusions
Very high lipoprotein(a) levels and very high Body mass index, together was associated with a 3.5-fold greater risk of calcified aortic valve disease.
The 10-year absolute risk of aortic valve calcification ranged from 0.4% to 14% by lipoprotein(a) level, body mass index, age, and sex.
Research Reviews
Calcific aortic valve disease (CAVD)historicallyrecognized as a degenerative diseaselesion span>.
Over the past 20 years, researchconsidered that secondary risk factors similar to coronary artery disease (CAD).
In 2011, the National Heart, Lung and Blood Institute CAVD Working Group determined that the biological properties of calcification are no longer Considered a degenerative disease, reverselyis an active cellular osteogenic process.
Initial phase versus traditional atherosclerosis risk factors, including smoking, male sex,BMI, hypertension, elevated lipids and inflammatory markers Hypertension, metabolic syndrome and renal failure are strongly associated.
2013, research findings Genetic variation of LPA gene locus mediated by lipoprotein(a) levels is associated with aortic valve calcification and clinical aortic stenosis . At the same time, the results of in vitro and in vivo experimental models of valve calcification show that the differentiation of valve interstitial cells into osteoblasts leads to valve calcification while the specific risk factors for CAVD appear. This calcification process is called osteocardiology, or bone formation in the heart.
In thisCopenhagenGeneralpopulation studies, high lipoprotein (a) levels and high body mass index (BMI) together resulted in a 3.5-fold increase in CAVD risk. In addition, based on lipoprotein(a) level, BMI, age and genderetc.Risk FactorsA 10-year risk analysis was performed, and the absolute risk of CAVD within 10 years was as high as 14%.
Figure 4 Progression of aortic valve sclerosis to stenosis and lipoprotein(a) or BMI Novel role of elevation in increased CAVD risk
This study reconfirms that with the The gradient of CAVD increased by 3.5 times.
Similar results to the RAAVE trial were also found in another study in Copenhagen, which was also sub-analyzed using the SEAS cohort. We focused on patients with elevated LDL levels in the SEAS cohort to confirm the hypothesis that targeting higher concentrations of lipoproteins in the early stages of the disease slows the progression of CAVD.
In this new Copenhagen study, higher BMI and lipoprotein(a) were associated with higher risk of CAVD The more likely it is.
The findings bring the field one step closer to identifying the goal of future medical treatments, the future of medical treatment for CAVD. When CAVD-specific risk factors, including lipoprotein(a), high BMI, and CAVD-specific hemodynamics are included, future randomized clinical trials of CAVD, including lipid-hemodynamic biological interactions, will Helps to delay the timing of aortic valve replacement, allowing patients to have a healthier heart.
Source:
Lipoprotein(a) and Body Mass Compound the Risk of Calcific Aortic Valve Disease. J Am Coll Cardiol 2022;79:545–558
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