Abstract / Description of output
Importance: There are currently no pharmacological treatments available to slow hemodynamic progression of aortic stenosis. Plasma lipoprotein(a) concentrations predict incident aortic stenosis but its association with hemodynamic progression is controversial.
Objectives: To determine the association between plasma lipoprotein(a) concentrations and hemodynamic progression in patients with aortic stenosis.
Design, settigs and participants: We included 710 patients with aortic stenosis from five longitudinal clinical studies with data on plasma lipoprotein(a) concentrations and rates of hemodynamic progression assessed by echocardiography.
Exposure: Cohort-specific plasma lipoprotein(a) concentration tertiles.
Main outcomes measures: Hemodynamic aortic stenosis progression on echocardiography as assessed by annualized change in peak aortic jet velocity, mean transvalvular gradient and aortic valve area.
Results: In a random-effects meta-analysis of the five cohorts, patients in the top lipoprotein(a) tertile demonstrated 41% (estimate = 1.41, 95% CI=1.13-1.75) faster progression of peak aortic jet velocity and 57% (estimate = 1.57, 95% CI=1.18-2.10) faster progression of mean transvalvular gradient than patients in the bottom tertile. There was no evidence of heterogeneity across the individual cohorts. Progression of aortic valve area was comparable between groups (estimate = 1.23 [(95% CI=0.71-2.12). Similar results were observed when plasma lipoprotein(a) concentrations were treated as a continuous variable.
Conclusions and relevance: In aortic stenosis, higher plasma lipoprotein(a) concentrations are associated with faster rates of hemodynamic progression. Lowering plasma lipoprotein(a) concentrations warrants further investigation in the prevention and treatment of aortic stenosis.
Objectives: To determine the association between plasma lipoprotein(a) concentrations and hemodynamic progression in patients with aortic stenosis.
Design, settigs and participants: We included 710 patients with aortic stenosis from five longitudinal clinical studies with data on plasma lipoprotein(a) concentrations and rates of hemodynamic progression assessed by echocardiography.
Exposure: Cohort-specific plasma lipoprotein(a) concentration tertiles.
Main outcomes measures: Hemodynamic aortic stenosis progression on echocardiography as assessed by annualized change in peak aortic jet velocity, mean transvalvular gradient and aortic valve area.
Results: In a random-effects meta-analysis of the five cohorts, patients in the top lipoprotein(a) tertile demonstrated 41% (estimate = 1.41, 95% CI=1.13-1.75) faster progression of peak aortic jet velocity and 57% (estimate = 1.57, 95% CI=1.18-2.10) faster progression of mean transvalvular gradient than patients in the bottom tertile. There was no evidence of heterogeneity across the individual cohorts. Progression of aortic valve area was comparable between groups (estimate = 1.23 [(95% CI=0.71-2.12). Similar results were observed when plasma lipoprotein(a) concentrations were treated as a continuous variable.
Conclusions and relevance: In aortic stenosis, higher plasma lipoprotein(a) concentrations are associated with faster rates of hemodynamic progression. Lowering plasma lipoprotein(a) concentrations warrants further investigation in the prevention and treatment of aortic stenosis.
| Original language | English |
|---|---|
| Journal | JAMA Cardiology |
| Early online date | 17 Jul 2024 |
| DOIs | |
| Publication status | E-pub ahead of print - 17 Jul 2024 |