Physicians' Academy for Cardiovascular Education

ApoB/apoA-I ratio associated with risk of aortic valve stenosis in prospective population study

apoB/apoA-I Ratio and Lp(a) Associations With Aortic Valve Stenosis Incidence: Insights From the EPIC-Norfolk Prospective Population Study

Literature - Zheng KH, Arsenault BJ, Kaiser Y et al., - J Am Heart Assoc. 2019;8(16):e013020

Introduction and methods

The involvement of the atherogenic apolipoprotein B (apoB)-containing lipoproteins, such as LDL-c and lipoprotein (a) [lp(a)], in the pathogenesis of aortic valve stenosis (AVS) is well established [1,2]. Trials evaluating lowering LDL-c have, however, failed to show a favorable impact on AVS progression [3]. No Lp(a)-lowering trials have been conducted yet. Thus, there is currently no proven medical therapy to reduce disease progression of AVS.

The apoB/apolipoprotein A-I (apoA-I) ratio and Lp(a) have been described to be associated with future AVS surgery, only in patients with concomitant coronary artery disease (CAD), and not in those with ‘isolated AVS’ [4]. This suggests that different phenotypes of AVS exist, and different pathogenic mechanisms and risk factors may be involved. Other data have suggested that lipoprotein-mediated pathology may be dominant in younger patients, while other risk factors may be more relevant to disease progression in older patients [5]. Risk factors for AVS incidence and progression may also vary due to different pathophysiological processes depending on the stage of disease [6].

This study set out to assess the associations between apoB/apoA-I ratio, Lp(a) and AVS incidence in a prospective, longitudinal study (EPIC-Norfolk, 25,639 participants [7]). Moreover, it was assessed how clinical characteristics modify these associations. Complete data were available for 17,745 participants. 579 Participants reported a history of CAD at baseline and 3300 had a CAD incident during follow-up. After a median follow-up of 19.8 years, 403 (2.2%) incident AVS cases were noted.

Main results

ApoB/apoA-I ratio associated with risk of aortic valve stenosis in prospective population study


As a measure that reflects the balance between atherogenic apoB-containing particles and antiatherogenic HDL particles, the apoB/apoA-I ratio captures both dyslipidemia and dysmetabolic regulation. In the EPIC-Norfolk population study, the ratio was a strong predictor of AVS incidence, especially in younger and female participants. This supports the hypothesis that lipoproteins are involved in the pathogenesis of AVS. Lp(a) was an independent risk factor for AVS incidence.


Show references

Download the slide Find this article online at J Am Heart Assoc

Share this page with your colleagues and friends: