TY - JOUR
T1 - Aspirin use, lipoprotein(a), and calcific aortic valve disease
T2 - the Multi-ethnic Study of Atherosclerosis
AU - Razavi, Alexander C.
AU - Bhatia, Harpreet S.
AU - Marrero, Natalie
AU - Dzaye, Omar
AU - Post, Wendy S.
AU - Nasir, Khurram
AU - Tsai, Michael
AU - Vaccarino, Viola
AU - Vasan, Ramachandran S.
AU - Thanassoulis, George
AU - Tsimikas, Sotirios
AU - Sperling, Laurence S.
AU - Budoff, Matthew J.
AU - Blumenthal, Roger S.
AU - Blaha, Michael J.
AU - Whelton, Seamus P.
N1 - Publisher Copyright:
© The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected]. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights)
PY - 2026/9/7
Y1 - 2026/9/7
N2 - Background and Aims: Lipoprotein(a) [Lp(a)] and LDL cholesterol (LDL-C) are causally linked to aortic valve calcium (AVC) and aortic stenosis (AS). Lipoprotein(a) has anti-fibrinolytic properties; therefore, aspirin may reduce cardiovascular disease risk among individuals with high Lp(a). This analysis sought to determine the association of aspirin with incident AVC and AS across Lp(a) and LDL-C levels. Methods: This observational study included up to 6598 participants in the Multi-Ethnic Study of Atherosclerosis. Aortic valve calcium was measured on non-contrast cardiac computed tomography. Multivariable Cox hazards regression assessed the association of self-reported regular aspirin use (≥3 days/week) with incident AVC and severe AS, stratified by Lp(a) and LDL-C. Aortic valve calcium and Lp(a) values were not reported to participants. Results: Mean age was 62 years, 53% were women, 23% reported regular aspirin use, 8% developed AVC (median 8.9 years), and 1% developed severe AS (median 16.7 years). Among individuals with elevated Lp(a), regular aspirin use was associated with a lower risk of incident AVC (Lp(a) ≥75 mg/dL: hazard ratio (HR) .42, 95% confidence interval (CI) .19–.93; Lp(a) ≥100 mg/dL: HR .17, 95% CI .04–.67) and severe AS (Lp(a) ≥50 mg/dL: HR .13, 95% CI: .04–.47; Lp(a) ≥75 mg/dL: HR .02, 95% CI .001–.29). For participants with elevated LDL-C, there was no association of regular aspirin use with incident AVC (LDL-C ≥130 mg/dL: HR 1.02, 95% CI .66–1.58; LDL-C ≥160 mg/dL: HR 1.51, 95% CI .53–4.28) or severe AS (LDL-C ≥100 mg/dL: HR .70, 95% CI .39–1.26; LDL-C ≥130 mg/dL: HR .46, 95% CI .14–1.47). Conclusions: In this exploratory analysis of prospective observational cohort data, regular aspirin use was associated with a lower risk of AVC and severe AS in persons with high Lp(a), but not high LDL-C. Confirmatory studies are required to determine the role of aspirin in the prevention of AVC and AS for persons with high Lp(a).
AB - Background and Aims: Lipoprotein(a) [Lp(a)] and LDL cholesterol (LDL-C) are causally linked to aortic valve calcium (AVC) and aortic stenosis (AS). Lipoprotein(a) has anti-fibrinolytic properties; therefore, aspirin may reduce cardiovascular disease risk among individuals with high Lp(a). This analysis sought to determine the association of aspirin with incident AVC and AS across Lp(a) and LDL-C levels. Methods: This observational study included up to 6598 participants in the Multi-Ethnic Study of Atherosclerosis. Aortic valve calcium was measured on non-contrast cardiac computed tomography. Multivariable Cox hazards regression assessed the association of self-reported regular aspirin use (≥3 days/week) with incident AVC and severe AS, stratified by Lp(a) and LDL-C. Aortic valve calcium and Lp(a) values were not reported to participants. Results: Mean age was 62 years, 53% were women, 23% reported regular aspirin use, 8% developed AVC (median 8.9 years), and 1% developed severe AS (median 16.7 years). Among individuals with elevated Lp(a), regular aspirin use was associated with a lower risk of incident AVC (Lp(a) ≥75 mg/dL: hazard ratio (HR) .42, 95% confidence interval (CI) .19–.93; Lp(a) ≥100 mg/dL: HR .17, 95% CI .04–.67) and severe AS (Lp(a) ≥50 mg/dL: HR .13, 95% CI: .04–.47; Lp(a) ≥75 mg/dL: HR .02, 95% CI .001–.29). For participants with elevated LDL-C, there was no association of regular aspirin use with incident AVC (LDL-C ≥130 mg/dL: HR 1.02, 95% CI .66–1.58; LDL-C ≥160 mg/dL: HR 1.51, 95% CI .53–4.28) or severe AS (LDL-C ≥100 mg/dL: HR .70, 95% CI .39–1.26; LDL-C ≥130 mg/dL: HR .46, 95% CI .14–1.47). Conclusions: In this exploratory analysis of prospective observational cohort data, regular aspirin use was associated with a lower risk of AVC and severe AS in persons with high Lp(a), but not high LDL-C. Confirmatory studies are required to determine the role of aspirin in the prevention of AVC and AS for persons with high Lp(a).
KW - Aortic stenosis
KW - Aortic valve calcium
KW - Aortic valve disease
KW - Aspirin
KW - Computed tomography
KW - LDL cholesterol
KW - Lipoprotein(a)
UR - https://www.scopus.com/pages/publications/105049616258
UR - https://www.scopus.com/pages/publications/105049616258#tab=citedBy
U2 - 10.1093/eurheartj/ehag018
DO - 10.1093/eurheartj/ehag018
M3 - Article
C2 - 41721439
AN - SCOPUS:105049616258
SN - 0195-668X
VL - 47
SP - 4792
EP - 4801
JO - European heart journal
JF - European heart journal
IS - 34
ER -