Abstract P2078: Extreme Lipoprotein(a) Levels and the Hazard of Acute Myocardial Infarction Among Standard Modifiable Cardiovascular Risk Factors in the United States

Abstract

Background: Lipoprotein(a) [Lp(a)] is a risk factor for atherosclerotic cardiovascular disease, including acute myocardial infarction (AMI). Currently, no Lp(a) targeted pharmaceutical treatments are available in the U.S. While Lp(a) has previously shown prognostic value among patients without standard modifiable risk factors (SMuRFs), data is limited among patients with SMuRFs. This study examined the variation in Lp(a) and AMI association by SMuRFs’ number. Hypothesis: We hypothesized that the association between extremely high Lp(a) (XHI) levels and AMI among U.S. adults would differ by SMuRFs’ number with an increased AMI hazard among those with more SMuRFs. Methods: This retrospective study included U.S. adults with ≥1Lp(a) lab result between 01/01/2016-01/31/2023 identified in the Veradigm Network Electronic Health Records (VNEHR) linked to closed claims. Patients had EHR/claims activity ≥13 months prior to and ≥12 months following the index date (30 days post-first Lp(a) test). Patients were stratified by Lp(a) value into low (LO, <50 th percentile) and XHI (>90 th percentile) cohorts. SMuRFs at baseline were defined as hypertension, dyslipidemia, diabetes, chronic kidney disease, current or former smoker, alcohol use disorder, and BMI <18.5 or ≥25. Descriptive analyses were completed in SQL and SAS. Multivariable analyses are ongoing to examine AMI’s association with XHI Lp(a) by the number of SMuRFs. Results: Among the 17,819 patients meeting the inclusion criteria, 1,776 and 8,999 were assigned to the XHI and LO cohorts. Patients overall were 52.9 years old, 59% female, and 59% white. The XHI cohort had a greater proportion of patients with 3 SMuRFs (23.4% vs. 19.0%) and > 4 SMuRFs (15.7% vs. 11.5%) and a lower proportion with 0 SMuRFs (6.6% vs. 11.0%) vs. the LO cohort (all p<0.001). Baseline dyslipidemia (84.0% vs. 74.2%), hypertension (42.1% vs. 35.3%), and diabetes (19.5% vs. 15.7%) were observed more commonly among XHI vs. LO patients (all p<0.001). During a mean follow-up of 3.9-years, AMI incidence was low (<1.5%) and did not differ between Lp(a) cohorts. Conclusions: Patients in the XHI cohort were more likely to have ≥3 SMuRFs and baseline risk factors vs. the LO cohort. Although few patients had an AMI during the follow-up period, the higher presence of SMuRFs and risk factors within the XHI cohort underscore a pressing public health need. Additionally, a longer follow-up period may help better understand SMuRFs’ contribution to AMI hazard.