Abstract 16773: The Association of Lp(a) and Standard Modifiable Cardiovascular Risk Factors (SMuRFs) With Incident Myocardial Infarction: The Mass General Brigham Lp(a) Registry

Abstract

Introduction: Lp(a) is a robust predictor of coronary heart disease outcomes, with targeted therapies currently under investigation. However, there is a paucity of data regarding the risk of elevated Lp(a) in relation to other cardiovascular risk factors. Objective: To evaluate the association of high Lp(a) with standard modifiable risk factors (SMuRFs) for incident first acute myocardial infarction (AMI). Methods: This retrospective study utilized the MGB Lp(a) Registry which included patients ≥18 years with an Lp(a) measurement between 2000-2019. Exclusion criteria were severe kidney dysfunction, malignant neoplasm, and prior known atherosclerotic cardiovascular disease (ASCVD). Diabetes mellitus, hyperlipidemia, hypertension, and smoking were considered SMuRFs. High Lp(a) was defined as >90 th percentile and low Lp(a) as <50 th . The primary outcome was fatal or non-fatal AMI. A combination of natural language processing algorithms, ICD codes, and laboratory data were employed to identify the outcome and covariates. Results: A total of 6,238 patients met the eligibility criteria. The median age was 54 (IQR: 43-65) years and 45% were women. Overall, 23.7% had no SMuRFs and 17.8% had ≥3 SMuRFs. Over a median follow-up of 8.8 (IQR: 4.2-12.8) years, the incidence of AMI increased in a stepwise manner with higher number of SMuRFs among patients with high (logrank p=0.031) and low Lp(a) (logrank p<0.001). Across all SMuRFs subgroups, the incidence of AMI was significantly higher for patients with high Lp(a) vs. low Lp(a) (Figure 1). The risk of high Lp(a) was higher than the risk imposed by any of the SMuRFs and was similar to having two SMuRFs. Following adjustment for confounders and number of SMuRFs, high Lp(a) remained independently associated with the primary outcome (HR=2.9 (95%CI=2.0-4.3), p<0.001). Conclusions: Among patients with no prior ASCVD, high Lp(a) is independently associated with increased risk for first AMI regardless of the number of SMuRFs.