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

J Am Coll Cardiol. 2022 Feb 15;79(6):545-558. doi: 10.1016/j.jacc.2021.11.043.


Background: High plasma lipoprotein(a) and high body mass index are both causal risk factors for calcific aortic valve disease.

Objectives: This study sought to test the hypothesis that risk of calcific aortic valve disease is the highest when both plasma lipoprotein(a) and body mass index are extremely high.

Methods: From the Copenhagen General Population Study, we used information on 69,988 randomly selected individuals recruited from 2003 to 2015 (median follow-up 7.4 years) to evaluate the association between high lipoprotein(a) and high body mass index with risk of calcific aortic valve disease.

Results: Compared with individuals in the 1st to 49th percentiles for both lipoprotein(a) and body mass index, the multivariable adjusted HRs for calcific aortic valve disease were 1.6 (95% CI: 1.3-1.9) for the 50th to 89th percentiles of both (16% of all individuals) and 3.5 (95% CI: 2.5-5.1) for the 90th to 100th percentiles of both (1.1%) (P for interaction = 0.92). The 10-year absolute risk of calcific aortic valve disease increased with higher lipoprotein(a), body mass index, and age, and was higher in men than in women. For women and men 70-79 years of age with body mass index ≥30.0 kg/m2, 10-year absolute risks were 5% and 8% for lipoprotein(a) ≤42 mg/dL (88 nmol/L), 7% and 11% for 42-79 mg/dL (89-169 nmol/L), and 9% and 14% for lipoprotein(a) ≥80 mg/dL (170 nmol/L), respectively.

Conclusions: Extremely high lipoprotein(a) levels and extremely high body mass index together conferred a 3.5-fold risk of calcific aortic valve disease. Ten-year absolute risk of calcific aortic valve disease by categories of lipoprotein(a) levels, body mass index, age, and sex ranged from 0.4% to 14%.

Keywords: absolute risk; heart valve; lipoprotein; obesity; waist-hip ratio.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aortic Valve / pathology*
  • Aortic Valve Stenosis / blood*
  • Aortic Valve Stenosis / diagnosis
  • Aortic Valve Stenosis / epidemiology
  • Biomarkers / blood
  • Body Mass Index*
  • Calcinosis / blood*
  • Calcinosis / diagnosis
  • Calcinosis / epidemiology
  • Denmark / epidemiology
  • Female
  • Follow-Up Studies
  • Forecasting*
  • Humans
  • Incidence
  • Lipoprotein(a) / blood*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Young Adult


  • Biomarkers
  • Lipoprotein(a)

Supplementary concepts

  • Aortic Valve, Calcification of