Abstract
BACKGROUND: Patients suffering coronary artery disease (CAD) with calcific aortic valve disease (CAVD) are facing worse prognosis with more complex operation strategies. As the primary stage of CAVD, it is helpful to confirm the risk factors of aortic valve calcification (AVC) in advance for exploring the secondary prevention as well as early intervention strategies of CAVD for CAD patients. Lipoprotein(a) [Lp(a)] has been confirmed as the risk factor of both CAD and CAVD. But whether Lp(a) level still affects the occurrence and development of CAVD in CAD patients has not been demonstrated yet. OBJECTIVE: We firstly investigate the predictive value of Lp(a) for new-onset AVC in patients with CAD. METHODS: Patients who were admitted to the Department of Cardiology, Zhujiang Hospital, Southern Medical University from March 2021 to December 2022 and diagnosed with CAD by elective coronary angiography(CAG)were included when met the criteria. Baseline data were collected through the electronic medical record system. Patients were followed up to repeat echocardiography with an interval at least 6 months, which was up to September 2023. The primary endpoint was new-onset AVC, according to which patients were divided into new-onset AVC group (n = 43) and the opposite(n = 165). Analyses were conducted using SPSS 26.0 and GraphPad Prism 10.1.2. RESULTS: A total of 208 patients with CAD were included, with a median follow-up time of 16 (12, 20) months. Compared with AVC-free group, patients with new-onset AVC had higher body mass index (BMI) (p = 0.003), higher proportion of tree-vessel disease(p < 0.001), higher rates of diabetes (p = 0.001) and atrial fibrillation (p = 0.017), higher Lp(a) levels(p < 0.001), lower left ventricular systolic function (LVEF) (p < 0.001) and thicker left ventricular posterior wall (LVPW) (p < 0.001). Increased BMI, three-vessel disease, Lp(a) > 26.65 nmol/L, increased LVPW were found independent risk factors for new-onset AVC. Using a cutoff level of 26.65 nmol/L, Lp(a) predicted new-onset AVC with a sensitivity of 79.1% and a specificity of 59.4% (AUC: 0.740, 95% CI: 0.657-0.823, p < 0.001). When combined with BMI, there present a higher AUC value of 0.752(95%CI: 0.668-0.836, p < 0.001); however, the statistical significance remains limited (p = 0.732). CONCLUSION: High-level serum Lp(a) was independently associated with new-onset AVC in patients with CAD. Lp(a) demonstrates a significant predictive value for the onset of new AVC in CAD patients, with an established cut-off threshold of 26.65 nmol/L.