Abstract Body (Do not enter title and authors here):

Background.
Lipoprotein (a) (Lp(a)) and diabetes mellitus (DM) are both established risk factors for the development of cardiovascular disease. However, there is limited data regarding the impact of DM on cardiovascular outcomes in patients with elevated Lp(a).
Purpose.
This study aims to investigate the impact of DM on cardiovascular outcomes among patients with elevated Lp(a).
Methods.
This study utilized the TriNetX database (January 2016 to April 2022). A total of 19,942 adult patients (≥18 years) diagnosed with elevated Lp(a) were identified. Propensity score matching (PSM) (1:1) was conducted based on baseline characteristics. Our primary outcome was major adverse cardiovascular events (MACE) (a composite of incident acute myocardial infarction, ischemic stroke, and all-cause mortality) at a three-year follow-up. All outcomes were assessed using the hazard ratio (HR) and 95% confidence interval (CI).
Results.
Our study included 5,968 patients with elevated Lp(a) and DM, as well as 13,974 patients with elevated Lp(a) without DM. After PSM, there were 4,822 patients in each group. DM was significantly associated with a higher risk of MACE (HR: 1.430, 95% CI [1.229, 1.664], p < 0.001), atherosclerotic cardiovascular disease (HR: 1.151, 95% CI [1.081, 1.227], p < 0.001), new-onset heart failure (HR: 1.463, 95% CI [1.230, 1.739], p < 0.001), cardiac-related hemodynamic instability (HR: 1.836, 95% CI [1.278, 2.640], p = 0.001), all-cause hospitalizations (HR: 1.405, 95% CI [1.263, 1.563], p < 0.001), and all-cause mortality (HR: 1.343, 95% CI [1.117, 1.615], p = 0.002). However, there was no significant difference between the presence of DM and its absence in new-onset atrial fibrillation and new-onset aortic valve stenosis.
Conclusions.
The presence of DM in patients with elevated Lp(a) levels was significantly associated with an increased risk of MACE, atherosclerotic cardiovascular disease, new-onset heart failure, cardiac-related hemodynamic instability, all-cause hospitalizations, and all-cause mortality. However, there was no significant difference between the presence of DM and its absence in new-onset atrial fibrillation and new-onset aortic valve stenosis.