Impact of Social Determinants of Health and Lifestyle on Association Between Lipoprotein(a) and Cardiovascular Events.

Background: In European cohorts, healthier lifestyle either attenuated or associated with lower cardiovascular risk despite elevated lipoprotein(a) [Lp(a)].

Objectives: The purpose of this study was to test if social determinants of health (SDOH) and Life's Simple 7 (LS7) scores impact the association of Lp(a) with cardiovascular events in U.S. cohorts.

Methods: We performed a sequential multivariable Cox proportional hazard analysis using the ARIC (Atherosclerosis Risk In Communities) and MESA (Multi-Ethnic Study of Atherosclerosis) cohorts. We first adjusted for age, gender, non-high-density lipoprotein-cholesterol, race, and ethnicity, then sequentially added SDOH and LS7 scores. The primary outcomes were time until first myocardial infarction (MI) or stroke.

Results: ARIC (n = 15,072; median Lp(a) = 17.3 mg/dL) had 16.2 years and MESA (n = 6,822; median Lp(a) = 18.3 mg/dL) had 12.3 years of average follow-up. In age, gender, race, and ethnicity, and non-high-density lipoprotein-cholesterol adjusted analyses, Lp(a) was associated with MI in ARIC (HR: 1.10,  < 0.001) and MESA (HR: 1.11, 0.001), and stroke in ARIC (HR: 1.07,  < 0.001) but not MESA (HR: 0.97, 0.53). In models with SDOH and LS7, associations of Lp(a) remained similar with MI (ARIC, HR: 1.08,  < 0.001; MESA, HR: 1.10, 0.001) and stroke (ARIC, HR: 1.06, 0.002; MESA, HR: 0.96, 0.37). Each additional SDOH correlated positively with MI (ARIC, HR: 1.04, 0.01; MESA, HR: 1.08, 0.003) and stroke in ARIC (HR: 1.08, 0.00) but not MESA (HR: 1.03,  = 0.41). Each additional LS7 point correlated negatively with MI (ARIC, HR: 0.88,  < 0.001; MESA, HR: 0.85,  < 0.001) and stroke (ARIC, HR: 0.91,  < 0.001; MESA, HR: 0.86,  < 0.001).

Conclusions: SDOH and lifestyle factors associated with risk for MI and stroke but did not largely impact the association between Lp(a) and cardiovascular events.