Association between lipoprotein(a) and structural degeneration of bioprosthetic aortic valves: A systematic review and meta-analysis.

Background

Structural valve degeneration (SVD) remains a major limitation of bioprosthetic aortic valves (bAVs). Lipoprotein(a) [Lp(a)] is a genetically determined cardiovascular risk factor implicated in native aortic valve calcification, but its role in bioprosthetic valve degeneration remains incompletely understood.

Objective

To systematically evaluate the association between elevated Lp(a) levels and structural degeneration of bAVs.

Methods

A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, EBSCOhost, and Cochrane Library databases were searched for studies evaluating Lp(a) and structural degeneration of bAVs in patients undergoing surgical or transcatheter aortic valve replacement. Random-effects models were used to pool effect estimates. Cross-sectional outcomes were summarized using odds ratios (ORs), and longitudinal outcomes were pooled using hazard ratios (HRs), both with 95% CIs.

Results

Five observational cohort studies, including 1227 patients, were included. In cross-sectional analyses (2 studies), elevated Lp(a) levels were significantly associated with SVD (OR 2.09, 95% CI 1.02-4.28; I² = 0%). In longitudinal analyses (3 studies), elevated Lp(a) was associated with a higher risk of incident SVD or valve-related reintervention (HR 3.49, 95% CI 2.18-5.59; I² = 0%).

Conclusion

Elevated Lp(a) levels are associated with an increased risk of structural degeneration in bAVs. Lp(a) may represent a useful biomarker for identifying patients at higher risk of valve deterioration and may have implications for surveillance strategies and emerging Lp(a)-lowering therapies.