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5 79 | Lp(a) and AoVC in FH as a representative of the 3 parameters. The association between Lp(a) concentration and AVC was not influenced by CYS and/or CAC adjustment. Moreover, after adjustment for all significant determinants of AVC from the univariate model (age, BMI, SBP, DBP, duration of statin use, CYS and CAC score), Lp(a) concentrations remained a significant predictor for AVC. A 10 mg/dL-increase in Lp(a) concentration was associated with an 11% increased risk of developing AVC (95%CI = 1.01-1.20, p = 0.03). Table 5.3 | Adjusted association of Lp(a) concentration with aortic valve calcification (AVC) in patients with familial hypercholesterolemia (FH). Adjusted for Odds ratio 5 * 95%CI p CYS 1.10 1.02-1.20 0.02 CAC score 1.14 1.05-1.23 0.002 CYS and CAC score 1.13 1.04-1.22 0.005 Age, BMI, SBP, DBP, Duration of statin use, CYS and CAC score 1.11 1.01-1.20 0.03 Odds ratios were calculated per 10 mg/dL increase of Lp(a) concentration, CYS: cholesterol-year score, CAC: coronary artery calcification, SBP: systolic blood pressure, DBP: diastolic blood pressure In clinic, Lp(a) cutoff values of 30 or 50mg/dL are used. Plasma Lp(a) concentrations over 30 mg/dL were not significantly associated with an increased risk of AVC (OR(95%CI) = 1.80(0.88-3.70), p = 0.11). Plasma Lp(a) concentrations above 50 mg/dL were associated with a 2.57-fold increased risk of AVC (95%CI = 1.20-5.52, p = 0.02). However, after adjustment for parameters selected from the univariate analysis, the association no longer reached statistical significance (OR(95%CI) = 2.03 (0.80-5.18), p = 0.14). Discussion Little is known about the development of valvular calcification in patients with heterozygous FH. The exposure to classical risk factors is not a sufficient explanation for the development of AVC in these statin-treated patients. In the present study, we report, for the first time, a significant association of plasma Lp(a) concentrations with AVC in asymptomatic statin-treated heterozygous FH patients. After adjustment for age and other CVD-related parameters, Lp(a) concentration was still associated with AVC, suggesting that Lp(a) might be used as an independent risk marker for AVC in these