Aortic valve calcium (AVC) and aortic stenosis (AS) remain progressive conditions with limited preventive strategies, particularly among individuals with elevated lipoprotein(a) [Lp(a)]. An exploratory prospective observational analysis from the Multi-Ethnic Study of Atherosclerosis, published in the European Heart Journal, evaluated whether regular aspirin use was associated with incident AVC and severe AS across Lp(a) and LDL cholesterol (LDL-C) levels.

The study included up to 6,598 participants (mean age 62 years; 53% women), with 23% reporting regular aspirin use (≥3 days/week). Multivariable Cox hazards regression assessed associations with incident AVC, measured by non-contrast cardiac computed tomography, and severe AS. Over a median 8.9 years, 8% developed AVC; over 16.7 years, 1% developed severe AS.

Among individuals with elevated Lp(a), aspirin use was associated with lower risk of incident AVC (Lp(a) ≥75 mg/dL: HR 0.42; 95% CI 0.19-0.93) and severe AS (Lp(a) ≥50 mg/dL: HR 0.13; 95% CI 0.04–0.47). No significant association was observed among participants with elevated LDL-C (LDL-C ≥130 mg/dL: HR 1.02; 95% CI 0.66-1.58).

In this exploratory prospective cohort analysis, regular aspirin use showed an association with lower incidence of AVC and severe AS among individuals with elevated Lp(a), whereas no such association was observed in those with elevated LDL-C. These findings do not establish causality, and additional studies are needed to clarify whether aspirin has a preventive role in individuals with high Lp(a).