Abstract 12706: The Impact of Social Determinants of Health and Lifestyle Factors on the Association of Lipoprotein(a) With Cardiovascular Outcomes in Two US Cohorts

Abstract

Introduction: In European cohorts, a higher Mediterranean diet or Life’s Simple 7 (LS7) score abolished or attenuated the risk associated with increasing Lipoprotein(a) [Lp(a)] on cardiovascular (CV) outcomes. This is unstudied in US cohorts. Further, the impact of social determinants of health (SDOH) on the association of Lp(a) with CV outcomes is unstudied. Hypothesis: We hypothesized that SDOH and LS7 scores would attenuate the association of Lp(a) with CV outcomes in US cohorts. Methods: We used data from the Atherosclerosis Risk in Communities (ARIC) and the Multi-Ethnic Study of Atherosclerosis (MESA) studies. Outcomes were time until first fatal or nonfatal myocardial infarction (MI) or stroke. We performed multivariable cox proportional hazard analyses with covariates of age, gender, race and ethnicity, SDOH score, and LS7 score. We identified five SDOH in ARIC and 11 in MESA. The Lp(a) protein-mass from ARIC was tripled to be similar to the Lp(a) total-mass measurement in MESA. Results: ARIC included 15,072 individuals (median Lp(a) = 17.3 mg/dL (IQR 7.5, 40.6)) with 16.2 years average follow up. MESA included 6,822 individuals (Median Lp(a) = 18.3 (IQR 6.9, 43.8)) with 12.3 year average follow up. In age, gender, and race and ethnicity adjusted analyses Lp(a) was associated with MI in ARIC (HR 1.10, p<0.001) and MESA (HR 1.09, p<0.001). Lp(a) was also associated with stroke in ARIC (HR 1.08, p<0.001) but not MESA (HR 0.97, p=0.50). With SDOH and LS7 added to the model, association of Lp(a) with CV outcomes remained similar in ARIC and MESA. SDOH correlated positively and LS7 correlated negatively with MI and stroke. In MESA there was an interaction between LS7 score and Lp(a) for MI. Conclusions: Lp(a) remained similarly associated with CV outcomes in US cohorts after accounting for social and lifestyle factors, although LS7 score may have a small modifying effect on the association between Lp(a) and MI. SDOH and LS7 are strong predictors for CV outcomes.