Is the atherogenic index a marker for mitral valve stenosis?

Objective: To demonstrate whether the atherogenic index has an effect on mitral valve pathologies in patients who underwent mitral valve replacement. Material and Methods: 156 patients who underwent isolated mitral valve replacement between 2006 and 2021 were included in the study. Mitral valve pathologies were categorized as calcific, rheumatic, and fibrotic based on echocardiography reports from patient archives, along with grouping according to the presence of mitral valve stenosis or regurgitation. Demographic data and comorbidities (hypertension, diabetes, chronic kidney disease, thyroid dysfunction, respiratory diseases) of these patients were recorded. Additionally, HDL (high-density lipoprotein), LDL (low-density lipoprotein), and triglyceride values were obtained from the hospital database to calculate atherogenic indexes. All this data was analyzed using the Mann Whitney U test, Kruskal Wallis-H test, and Chi-square test, with a significance level of p < 0.05. Findings: 46 patients (19.5%) had diabetes mellitus (DM), 137 (58.1%) had hypertension, 23 (9.7%) had chronic kidney disease, 48 (20.3%) had respiratory diseases (asthma/COPD), and 32 (13.6%) had thyroid dysfunction. It was found that the presence of DM, HT, CKD, Asthma/COPD, or Thyroid did not significantly affect the Atherogenic Index (p > 0.05). The mean LDL value was 110.41 ± 36.96, mean HDL was 48.09 ± 15.77, and mean triglyceride was 143.92 ± 75.76. It was observed that the mean HDL value was significantly lower in high-risk individuals compared to moderate-risk individuals (p = 0.004). Additionally, the mean triglyceride value was significantly higher in high-risk individuals compared to moderate and low-risk individuals (p < 0.001). No statistically significant difference was found in the average LDL and EF values of patients who underwent valve replacement based on risk status (p > 0.05). The lowest Atherogenic Index was -0.33, the highest was 1.12, with a mean of 0.44 ± 0.26. It was determined that the atherogenic index risk in valve patients did not have a statistically significant effect in the presence of mitral stenosis, mitral regurgitation, rheumatic, fibrotic mitral valve, and mitral calcification (p > 0.05). Discussion: The atherogenic index is used as a risk scoring system for coronary artery diseases, carotid and peripheral artery diseases, and aortic valve diseases. Dyslipidemia, characterized by increased LDL and triglycerides and decreased HDL levels, is a serious risk factor for these pathologies. Increased LDL and triglyceride levels accelerate the atherosclerotic process by accumulating lipid and calcium deposits through macrophage activation in the endothelium, leading to valve calcification, thickening, stenosis, or regurgitation. HDL, however, exhibits endothelial protective effects. Nevertheless, there are differences between mitral and aortic valve calcification and pathologies. While some studies have shown that the atherogenic index and LDL, triglyceride values are effective in mitral valve calcification and stenosis, our study did not find a significant relationship between these values and mitral valve pathologies. Keywords: Atherogenic index of plasma, Mitral stenosis, Dyslipidemia