Kim Ah-Ram, Ahn Jung-Min, Kang Do-Yoon, Jun Tae Joon, Sun Byung Joo, Kim Ho Jin, Kim Joon Bum, Kim Dae-Hee, Park Duk-Woo, Kim Young-Hak, Han Ki Hoon, Park Seung-Jung
Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Big Data Research Center, Asan Institute for Life Science, Asan Medical Center, Seoul, Republic of Korea.
JACC Asia. 2024 Sep 10;4(10):751-760. doi: 10.1016/j.jacasi.2024.07.007. eCollection 2024 Oct.
Lipoprotein(a) (Lp[a]) is associated with the development of aortic valve calcification.
The aim of this study was to evaluate the association between the serum level of Lp(a) and the development of severe degenerative aortic stenosis (AS) and subsequent aortic valve replacement (AVR).
A total of 44,742 patients with Lp(a) measurements and echocardiography at baseline evaluation between 2000 and 2020 were included from a single tertiary heart center. The primary outcome was the development of severe degenerative AS, defined as a transaortic maximal velocity of ≥4.0 m/s.
During a median follow-up period of 6.8 years (Q1-Q3: 2.3-12.4 years), severe degenerative AS was diagnosed in 472 patients (1.1%), and subsequent AVR was performed in 387 patients (0.9%). Lp(a) levels were associated with risk for severe degenerative AS, with levels of 30 to 50, 50 to 100, and >100 mg/dL demonstrating adjusted HRs of 1.02 (95% CI: 0.78-1.34; = 0.88), 1.18 (95% CI: 0.91-1.53; = 0.22), and 1.96 (95% CI: 1.31-2.94; = 0.001) compared to <30 mg/dL. Similarly, the risk for AVR due to severe degenerative AS was significantly associated with higher levels of Lp(a) (>100 mg/dL) (adjusted HR: 2.05; 95% CI: 1.31-3.19; = 0.002). Such associations were not observed in the development of severe bicuspid ( = 0.63) or rheumatic ( = 0.96) AS.
Lp(a) levels >100 mg/dL were significantly associated with risk for severe degenerative AS and subsequent AVR, regardless of the baseline severity of AS. Such associations were not observed in other etiologies of severe AS.
脂蛋白(a)[Lp(a)]与主动脉瓣钙化的发生有关。
本研究旨在评估血清Lp(a)水平与严重退行性主动脉瓣狭窄(AS)的发生及随后的主动脉瓣置换术(AVR)之间的关联。
从一个单一的三级心脏中心纳入了2000年至2020年期间在基线评估时进行了Lp(a)测量和超声心动图检查的44742例患者。主要结局是严重退行性AS的发生，定义为经主动脉最大流速≥4.0m/s。
在中位随访期6.8年（四分位间距：2.3 - 12.4年）内，472例患者（1.1%）被诊断为严重退行性AS，387例患者（0.9%）接受了随后的AVR。Lp(a)水平与严重退行性AS的风险相关，与<30mg/dL相比，30至50、50至100以及>100mg/dL水平的校正风险比分别为1.02（95%置信区间：0.78 - 1.34；P = 0.88）、1.18（95%置信区间：0.91 - 1.53；P = 0.22）和1.96（95%置信区间：1.31 - 2.94；P = 0.001）。同样，因严重退行性AS进行AVR的风险与较高的Lp(a)水平（>100mg/dL）显著相关（校正风险比：2.05；95%置信区间：1.31 - 3.19；P = 0.002）。在严重二叶式（P = 0.63）或风湿性（P = 0.96）AS的发生中未观察到此类关联。
无论AS的基线严重程度如何，Lp(a)水平>100mg/dL与严重退行性AS及随后AVR的风险显著相关。在其他严重AS病因中未观察到此类关联。
