Abstract 16471: Lipoprotein(a) Cholesterol and Cardiovascular Events in the VITamin D and OmegA 3 TriaL (Vital)

Background: It is unclear if lipoprotein(a) cholesterol (LpaC), the cholesterol carried by Lpa, is associated with CVD similar to Lpa mass, and if omega-3 fatty acids (n-3 FA) modify risk. Methods: 13,175 participants of the VITAL trial (NCT01169259) had baseline LpaC measured by density-gradient ultracentrifugation and were examined for incident CVD (n=416) by Cox models adjusted for risk factors. In a subset of participants (N=1639) with baseline and 1 year samples, we also analyzed randomized n-3 FA effects (1 g/d EPA+DHA) vs. placebo. Results: In unadjusted models, LpaC was associated with increased CVD risk (Table). After adjustment, risk was somewhat attenuated, with borderline significant association for LpaC >30 mg/dL (HR 1.37 [0.99, 1.90), p=0.056). N-3 FA increased median LpaC from 7 mg/dL (IQR, 5-10) at baseline to 8 mg/dL [IQR, 5-10] at 1 year (mean increase of 4.05% vs placebo, p=0.006 using natural logarithmic transformation for mean LpaC percent change). There was no effect modification (P interaction>0.05) by n-3 FA, race, sex or LDL-C. Conclusion: Very high LpaC had borderline significant increased risk for incident CVD, without diminution of levels or associated risk by n-3 FA treatment.