Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Heart. 2021 Sep;107(17):1422-1428. doi: 10.1136/heartjnl-2021-319044. Epub 2021 May 7.
To investigate the prevalence and quantity of aortic valve calcium (AVC) in two large cohorts, stratified according to age and lipoprotein(a) (Lp(a)), and to assess the association between Lp(a) and AVC.
We included 2412 participants from the population-based Rotterdam Study (52% women, mean age=69.6±6.3 years) and 859 apparently healthy individuals from the Amsterdam University Medical Centers (UMC) outpatient clinic (57% women, mean age=45.9±11.6 years). All individuals underwent blood sampling to determine Lp(a) concentration and non-enhanced cardiac CT to assess AVC. Logistic and linear regression analyses were performed to investigate the associations of Lp(a) with the presence and amount of AVC.
The prevalence of AVC was 33.1% in the Rotterdam Study and 5.4% in the Amsterdam UMC cohort. Higher Lp(a) concentrations were independently associated with presence of AVC in both cohorts (OR per 50 mg/dL increase in Lp(a): 1.54 (95% CI 1.36 to 1.75) in the Rotterdam Study cohort and 2.02 (95% CI 1.19 to 3.44) in the Amsterdam UMC cohort). In the Rotterdam Study cohort, higher Lp(a) concentrations were also associated with increase in aortic valve Agatston score (β 0.19, 95% CI 0.06 to 0.32 per 50 mg/dL increase).
Lp(a) is robustly associated with presence of AVC in a wide age range of individuals. These results provide further rationale to assess the effect of Lp(a) lowering interventions in individuals with early AVC to prevent end-stage aortic valve stenosis.
在两个大型队列中，根据年龄和脂蛋白(a)（Lp(a)）分层，研究主动脉瓣钙（AVC）的患病率和数量，并评估 Lp(a)与 AVC 之间的关联。
我们纳入了来自基于人群的鹿特丹研究（52%为女性，平均年龄=69.6±6.3 岁）的 2412 名参与者和阿姆斯特丹大学医学中心（UMC）门诊的 859 名貌似健康的个体（57%为女性，平均年龄=45.9±11.6 岁）。所有个体均接受了采血以确定 Lp(a)浓度，并进行非增强型心脏 CT 以评估 AVC。进行了逻辑和线性回归分析，以研究 Lp(a)与 AVC 的存在和数量之间的关联。
在鹿特丹研究中，AVC 的患病率为 33.1%，在阿姆斯特丹 UMC 队列中为 5.4%。在两个队列中，较高的 Lp(a)浓度与 AVC 的存在均独立相关（每增加 50mg/dL 的 Lp(a)，OR：鹿特丹研究队列中为 1.54（95%CI 1.36 至 1.75），阿姆斯特丹 UMC 队列中为 2.02（95%CI 1.19 至 3.44））。在鹿特丹研究队列中，较高的 Lp(a)浓度也与主动脉瓣 Agatston 评分的增加相关（β 0.19，95%CI 每增加 50mg/dL，增加 0.06 至 0.32）。
Lp(a)与广泛年龄范围内个体的 AVC 存在显著相关。这些结果为评估在早期 AVC 个体中降低 Lp(a)干预的效果以预防终末期主动脉瓣狭窄提供了更多依据。
