Epidemiology
In ARIC and MESA, healthier lifestyle and social determinants barely dent Lp(a)'s link to heart attack and stroke (JACC Adv 2024)
Original title: Impact of Social Determinants of Health and Lifestyle on Association Between Lipoprotein(a) and Cardiovascular Events
Using sequential multivariable Cox models in the ARIC (n = 15,072, median Lp(a) 17.3 mg/dL, 16.2-year follow-up) and MESA (n = 6,822, median Lp(a) 18.3 mg/dL, 12.3-year follow-up) cohorts, this study tested whether social determinants of health (SDOH) and Life's Simple 7 (LS7) lifestyle scores modify Lp(a)'s association with cardiovascular events. After adjusting for age, gender, race, ethnicity and non-HDL cholesterol, Lp(a) predicted myocardial infarction in both ARIC (hazard ratio 1.10, P < 0.001) and MESA (hazard ratio 1.11, P = 0.001), and stroke in ARIC (hazard ratio 1.07, P < 0.001) but not MESA (hazard ratio 0.97, P = 0.53). Adding SDOH and LS7 to the model barely changed these associations. Each additional SDOH burden and worse LS7 score independently predicted events in the expected directions, but did not meaningfully alter Lp(a)'s own relationship with cardiovascular events. Unlike some European cohorts where healthier lifestyle appeared to offset elevated Lp(a) risk, in these US cohorts social and lifestyle factors did not substantially attenuate Lp(a)'s cardiovascular risk.
Original abstract
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, P < 0.001) and MESA (HR: 1.11, P = 0.001), and stroke in ARIC (HR: 1.07, P < 0.001) but not MESA (HR: 0.97, P = 0.53). In models with SDOH and LS7, associations of Lp(a) remained similar with MI (ARIC, HR: 1.08, P < 0.001; MESA, HR: 1.10, P = 0.001) and stroke (ARIC, HR: 1.06, P = 0.002; MESA, HR: 0.96, P = 0.37). Each additional SDOH correlated positively with MI (ARIC, HR: 1.04, P = 0.01; MESA, HR: 1.08, P = 0.003) and stroke in ARIC (HR: 1.08, P = 0.00) but not MESA (HR: 1.03, P = 0.41). Each additional LS7 point correlated negatively with MI (ARIC, HR: 0.88, P < 0.001; MESA, HR: 0.85, P < 0.001) and stroke (ARIC, HR: 0.91, P < 0.001; MESA, HR: 0.86, P < 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.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.