👤 Aleksandra Gąsecka

Severe aortic stenosis can be treated with transcatheter aortic valve implantation (TAVI). There is emerging evidence suggesting that high lipoprotein(a) [Lp(a)] levels may be associated with worse outcomes after TAVI. To compare major adverse cardiac and cerebrovascular events (MACCE) within 12 months after TAVI and long-term survival between patients with high and low Lp(a) levels. In this prospective, multicenter cohort study we included patients with severe aortic stenosis qualified for TAVI with stored plasma available for Lp(a) measurement. Patients were stratified into high and low Lp(a) groups (cutoff 30 mg/dL). Two primary end points were analyzed: (i) 12-month MACCE, and (ii) long-term overall survival. Secondary end points were individual components of MACCE. Between November 2018 and September 2021, TAVI was performed across 3 clinical sites; stored plasma was available for Lp(a) measurement in 82 patients. We observed no difference in MACCE occurrence between high and low Lp(a) groups. In unadjusted analyses, patients with elevated Lp(a) had worse long-term survival during a median follow-up of 2.8 years (log-rank P = 0.045) but this difference lost significance after adjustments for age and sex in a Cox regression model (hazard ratio, 2.85; 95% CI, 0.85 to 9.55, P = 0.054). None of the secondary end points differed significantly between the groups. Patients with elevated Lp(a) have a comparable risk of 12-month MACCE after TAVI to those with low Lp(a) but might have worse long-term survival. Long-term findings should be considered exploratory and requires further confirmation. Show less

Lipoprotein(a) [Lp(a)] is a highly atherogenic particle that significantly increases overall cardiovascular risk. Evidence regarding concentrations of Lp(a) in the Polish general population remains limited, as well as the association between Lp(a) and various clinical characteristics. The aim in this study was to analyze Lp(a) concentration in a Polish population hospitalized in a tertiary referral hospital, compare clinical characteristics between patients with low and high Lp(a) and find the predictors of increased Lp(a) concentrations. This was an observational, cross-sectional study. All patients hospitalized in the Clinical Department of Internal Medicine, Endocrinology, Diabetology, and Nephrology in the Czerniakowski Hospital between 01.03.2024 and 08.10.2024 and with measured Lp(a) concentration were consecutively included. Patients were divided into two groups: those with high Lp(a) (≥ 30 mg/dL) and those with low Lp(a) ( < 30 mg/dL). The groups were compared in terms of multiple clinical characteristics. Multiple logistic regression was used to determine independent predictors of high Lp(a). The p-value below 0.05 was considered statistically significant. Out of 562 patients, 117 had high Lp(a) concentration (20.8%). The groups did not differ in terms of age, sex, or clinical examination findings. In a multiple logistic regression, male sex was associated with a decreased odds ratio of high Lp(a) (OR = 0.2857, 95% CI: 0.1107 to 0.6468, p = 0.01). High Lp(a) is prevalent in the Polish population, and thus it is important to measure it routinely in each individual at least once in a lifetime and control all other known cardiovascular risk factors to decrease the overall risk. Show less

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in Poland. Lipoprotein(a) [Lp(a)] constitutes an independent, causal risk factor for ASCVD and aortic valve stenosis. Elevated Lp(a) is found in approximately 20% of the Polish population. Lp(a) measurements have been recommended in all adult patients to improve cardiovascular risk stratification. As the testing rate remains insufficient, there is a need to facilitate the incorporation of Lp(a) into routine patient care. This clinically oriented review outlines (i) up-to-date evidence on the role of Lp(a) in cardiovascular diseases, (ii) recent real-world data on the characteristics of Polish patients with elevated Lp(a), and (iii) strategies for Lp(a) testing and management in light of the current national recommendations and the latest 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidemias. Show less