On 2/12/20, I had my 2nd AVR after just 7+ years. Yes, I know there are no answers "why" some valves fail far ahead of their lifespan estimates. My cardiologist and surgeon had no thoughts; sometimes it is just "luck", or genetics. That said, I personally found it dismaying to undergo this so soon, especially given a healthy diet and exercise regime.
Sooo, I did some digging on Google. There is some information on elevated lipoprotein (a) levels and early aortic valve stenosis and CV disease. My cardiologist ordered the blood test (NOT normally checked in standard cholesterol), and my level is 238! Anything over 75 is elevated.
Lp (a) is not responsive to statins, there is a strong genetic link, and currently there is no medication to lower levels. Frankly, I am not sure what will come of this information, but I certainly find it intriguing.
Hi Carol,
yes, elevated Lp(a) is causative for aortic stenosis. Mine was very similar to yours at 243 nmol/L. This puts us both at about the 95% and increases our risk substantially for heart disease and valve disease. I have BAV, so I have the double genetic whammy of having accelerated calcification from my BAV and elevated Lp(a), which studies have shown is likely causing my valve to calcify even faster than my BAV alone. Exercise and lifestyle can lower LDL, but this is not the case for Lp(a), which is technically a type of LDL, a very bad type of LDL. There are actually some things that can be done to lower Lp(a), including one prescription medication I mention below.
While statins are great for lowering LDL, they usually will raise Lp(a) 5% to 20% for most people. I believe that statins help a great number of people reduce their risk of CVD, but for those of us who have elevated Lp(a), it is important to be careful that the statin is not raising our risk level of CVD or valve disease, by raising our Lp(a). This is where the role of individualized medicine comes into play. One can get a baseline for LDL and Lp(a) and try to find the right statin and dose that lowers LDL to target, while only minimally impacting Lp(a). The effects on Lp(a) vary statin by statin, and by individual and also tends to be dose dependent. If a statin lowers LDL by 30 mg/dl but raises Lp(a) by 30 mg/dl, you are possibly doing more harm than good.
It is for the reasons above that I went off statins and went on PCSK9-I, which has the benefit of drastically lowering LDL, but also significantly lowering Lp(a). My Lp(a) has been lowered from 243 nmol/L down to its current level of 131 nmol/L. Here is how I lowered it:
My Lp(a) dropped about 6% going off of Lipitor.- statins raise Lp(a)
There is some evidence that high level fish oil, about 4g of EPA, can lower Lp(a) for some people. It lowered my Lp(a) about 5%, but some people have obtained better movement than that. Be sure to consult your doctor before going on that high level of fish oil. For me it means taking 4 capsules per day of a brand that has 1g per capsule of EPA.
But, my Lp(a) really dropped when I went on Repatha, which is a PCSK9-I. It dropped about another 40%. I am now at 131 nmol/L. This is still elevated above the desired level of being under 75 nmol/L, but way better than being at 243. Please note that Lp(a) is measured two ways; particles, which is expressed in nmol/L and in mass as mg/dl. If ones lab measures in mg/ dl, then you want to be under about 30mg/dl. The conversion factor is approximately 2.5x for most people. So yours would be something in the range of 95 mg/dl if converted.
In a post hoc analysis of the Fourier Trial, published in April 2020, hazard ratios were found to be significantly reduced for those with aortic stenosis who were on PCSK9-I. This is not surprising, given that PCSK9-I lowers Lp(a) and Lp(a) is causative for aortic stenosis. As they always say, more studies are needed and they need to do mendelian clinical trials on this specifically, this looks very promising with hope that PCSK9-I may actually slow calcification. Also, there is an antisense drug in its 3rd phase trial, which has been shown to lower Lp(a) 80-90%, so this is even better news for folks like us who have high levels of Lp(a)
Post hoc analysis of Fourier showing lower HR for those with aortic stenosis on PCSK9-I
https://jamanetwork.com/journals/ja...amacardiology&utm_content=olf&utm_term=042920
