LIPOPROTEIN(A) AND APOLIPOPROTEIN B ARE RELATED TO AORTIC STENOSIS: RESULTS FROM THE HISPANIC COMMUNITY HEALTH STUDY/STUDY OF LATINOS (HCHS/SOL) AND ECHOCARDIOGRAPHIC STUDY OF LATINOS (ECHO-SOL)

Abstract

Therapeutic Area

Heart Failure

Background

Lipoprotein(a) [Lp(a)] and Apolipoprotein B [apoB] have been previously studied as risk factors of calcific aortic valve disease primarily among non-Hispanic/Latino populations. However, the association between apoB and calcific aortic stenosis (AS) is not as well known.

Methods

Data from 8,564 community-dwelling Hispanics/Latinos with echocardiograms performed at Visit 2 (HCHS/SOL, 2014-2017 and Echo-SOL, 2015-2018) were analyzed. These participants had Lp(a) levels (nmol/L) and apoB levels (mg/dL) measured at HCHS/SOL Visit 1 (2008 to 2011). Pearson correlation coefficient (r), linear and logistic regression models were used to study the association of Lp(a) and apoB with the following outcomes: 1. Aortic valve peak velocity (AVPV), cm/s; 2. Aortic valve peak pressure gradient (AVPPG), mmHg, and 3. Aortic stenosis, defined as AVPV ≥ 300 cm/s for moderate or severe AS. AVPV ≤ 100 cm/s was considered normal and used as a reference value for AS. Lp(a) and apoB were modeled as continuous variables. Sampling weights and surveys methods were used to account for HCHS/SOL complex design.

Results

Overall, the mean (SE) age was 58.4 (0.2) years, and 53.6% were female. Their baseline median IQR (Q1-Q3) Lp(a) and apoB levels were 22.5 (8.1-66.6) nmol/L and 105.1 (88.7-122.9) mg/dL, respectively. HCHS/SOL overall baseline median IQR (Q1-Q3) Lp(a) was 19.7 (7.3-60.6) nmol/L and apoB was 96.7 (79.4-116.0) mg/dL, respectively. Table 1: Higher baseline Lp(a) levels were significantly associated with worsened AVPV and AVPPG at Visit 2. Higher apoB levels were associated with worsened AVPV and AVPPG. Compared to normal AVPV values, using 10-unit increments, increasing Lp(a) levels were associated with increased risk of moderate or severe AS (ORLp(a) 1.10 (95% CI, 1.06-1.14), p<0.0001); and increasing apoB levels were associated with mild AS or Aortic Sclerosis (ORapoB1.032 (95% CI, 1.002-1.063), p<0.04).

Conclusions

Lp(a) and apoB are significantly associated with AVPV and AVPPG and are significant predictors of AS; suggesting these markers may be potentially modifiable risk factors for calcific aortic valvular disease among Hispanic/Latinos.