How Fast Does Aortic Valve Stenosis Progress: The Lipoprotein(a) Factor

At the Kahn Center, we see many patients for evaluation of their coronary heart disease (CHD) and aortic valve stenosis (AVS) from a calcified valve. For over a decade, a routine lab test has been to measure Lipoprotein( a) or Lp(a) in all patients. Lp(a) is an important inherited factor in both CHD and AVS.

Unfortunately, as of now, there are currently no lifestyle or pharmacological treatments available to slow hemodynamic progression of AVS so we just watch it over time and intervene with surgical or catheter valve replace called TAVR when it is severe.

Plasma Lp(a) concentrations predict AVS but its association with hemodynamic progression is controversial. A new study provides information on this important topic. 

STUDY
The study included patients with aortic stenosis from 5 longitudinal clinical studies conducted from March 2001 to March 2023 in Canada and the UK. Of 757 total patients, data on plasma lipoprotein(a) concentrations and rates of hemodynamic progression assessed by echocardiography were available for 710, who were included in this analysis. Data were analyzed from March 2023 to April 2024.

MEASUREMENTS
 Hemodynamic aortic stenosis progression on echocardiography as assessed by annualized change in peak aortic jet velocity, mean transvalvular gradient, and aortic valve area.

RESULTS

Among the included patients, 497 (70%) were male and 213 (30%) were female. The mean age was 65 years.

Patients in the top lipoprotein(a) tertile demonstrated 41% faster progression of peak aortic jet velocity and 57% faster progression of mean transvalvular gradient than patients in the bottom tertile, both measures of echocardiography of the severity of the AVS.

CONCLUSIONS

In this study, higher plasma lipoprotein(a) concentrations were associated with faster rates of hemodynamic progression in patients with AVS.

What is unknown is whether lowering plasma Lp(a) concentrations wiil impact the progression of AVS. Prior studies with vitamin K2 and statins did not show a slowing of AVS over time.  The ongoing trials of new agents to lower Lp(a) may give some data on this important topic. 

At the Kahn Center, we do work with patients to lower their Lp(a) and have been quite successful using a multitude of approaches.