Physicians' Academy for Cardiovascular Education

Combination of high Lp(a) and high BMI confers highest risk of calcific aortic valve disease

Lipoprotein(a) and Body Mass Compound the Risk of Calcific Aortic Valve Disease

Literature - Kaltoft M, Langsted A, Afzal S et al. - J Am Coll Cardiol. 2022 Feb 15;79(6):545-558. doi: 10.1016/j.jacc.2021.11.043.

Introduction and methods

Background

Previous studies have demonstrated that elevated Lp(a) and BMI are separately associated with increased risk of calcific aortic valve disease (CAVD) [1-7]. However, it remains unknown whether a combination of these two risk factors can identify individuals at the highest risk of CAVD.

Aim of the study

This study evaluated the association between high Lp(a) and high BMI with risk of CAVD, and assessed the 10-year absolute risk for the most important risk factors of CAVD.

Methods

A total of 69,988 individuals from the Copenhagen General Population Study without CAVD and with information on both Lp(a) levels and BMI were included in this study. After a median follow-up of 7,4 years, the association between high Lp(a) and high BMI with risk of CAVD was evaluated. In head-to-head analyses comparing Lp(a) with BMI, Lp(a) and BMI were both categorized into groups of 1st to 49th, 50th to 89th, and 90th to 100th percentiles. For calculation of 10-year absolute risks, Lp(a)was categorized into the three groups based on clinical cutpoints (≤42 mg/dL [88 nmol/L], 43-79 mg/dL [89-169 nmol/L], and ≥80 mg/dL [170 nmol/L], and BMI was also categorized into three groups (normal weight [18.5-24.9 kg/m²], overweight [25.0-29.9 kg/m²] and obesity [≥30 kg/m²]).

Main results

Association of high Lp(a) and high BMI separately with CAVD

Association between the combination of high Lp(a) and high BMI with CAVD

Absolute 10-year risk of CAVD

Conclusion

The combination of Lp(a) levels and BMI in the top 10% conferred a 3.5-fold risk of CAVD compared with both risk factors in the bottom 50%. Absolute 10-year risk of CAVD was higher in men than in women and increased with higher age, Lp(a) and BMI, and ranged from 0.4% to 14%.

References

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Find this article online at J Am Coll Cardiol.

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