High-Density Lipoprotein and Long-Term Incidence and Progression of Aortic Valve Calcification: The Multi-Ethnic Study of Atherosclerosis

Anna E. Bortnick, Petra Buzkova, James D. Otvos, Majken K. Jensen, Michael Y. Tsai, Matthew J. Budoff, Rachel H. MacKey, Samar R. El Khoudary, Elda Favari, Ryung S. Kim, Carlos J. Rodriguez, George Thanassoulis, Jorge R. Kizer

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Background: Aortic valve calcification (AVC) shares pathological features with atherosclerosis. Lipoprotein components have been detected in aortic valve tissue, including HDL (high-density lipoprotein). HDL measures have inverse associations with cardiovascular disease, but relationships with long-term AVC progression are unclear. We investigated associations of HDL cholesterol, HDL-particle number and size, apoC3-defined HDL subtypes, and, secondarily, CETP (cholesteryl ester transfer protein) mass and activity, with long-term incidence and progression of AVC. Methods: We used linear mixed-effects models to evaluate the associations of baseline HDL indices with AVC. AVC was quantified by Agatston scoring of up to 3 serial computed tomography scans over a median of 8.9 (maximum 11.2) years of follow-up in the Multi-Ethnic Study of Atherosclerosis (n=6784). Results: After adjustment, higher concentrations of HDL-C (high-density lipoprotein cholesterol), HDL-P (HDL particles), large HDL-P, and apoC3-lacking HDL-C were significantly associated with lower incidence/progression of AVC. Neither small or medium HDL-P nor apoC3-containing HDL-C was significantly associated with AVC incidence/progression. When included together, a significant association was observed only for HDL-C, but not for HDL-P. Secondary analyses showed an inverse relationship between CETP mass, but not activity, and AVC incidence/progression. In exploratory assessments, inverse associations for HDL-C, HDL-P, large HDL-P, and apoC3-lacking HDL with AVC incidence/progression were more pronounced for older, male, and White participants. ApoC3-containing HDL-C only showed a positive association with AVC in these subgroups. Conclusions: In a multiethnic population, HDL-C, HDL-P, large HDL-P, and apoC3-lacking HDL-C were inversely associated with long-term incidence and progression of AVC. Further investigation of HDL composition and mechanisms could be useful in understanding pathways that slow AVC.

Original languageEnglish (US)
Pages (from-to)1272-1282
Number of pages11
JournalArteriosclerosis, thrombosis, and vascular biology
Volume42
Issue number10
DOIs
StatePublished - Oct 1 2022

Keywords

  • cardiovascular disease
  • cholesterol
  • cholesteryl ester transfer protein
  • incidence
  • lipoprotein

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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