Results: 35.6% of Georgia firefighters revealed coronary calcium compared to 18.5% of Monterey, California firefighters. When adjusted for age, 35.7% of Monterey, California firefighters revealed coronary calcium which was not significantly different from Georgia firefighters. Lipid values and fasting insulin were not different between states. hs-CRP was significantly higher in Georgia firefighters (p,0.000) and fibrinogen significantly higher in Monterey firefighters (p,0.0001). Laboratory markers of atheroscle- rosis risk in Monterey Firefighters with evidence of coro- nary artery calcification (CAC+) compared to those without (CAC-) revealed significantly higher fasting total choles- terol (p,0.04) and triglycerides (p,0.03), higher small dense LDL (p,0.02) and significantly higher markers of insulin resistance (p,0.002) (see Table). In CAC+ fire- fighters, 41% exhibited sdLDL . 30 mg/dl compared to 16% of CAC- firefighters (p,0.05), and 24% of CAC+ firefighters revealed a fasting insulin .15 uU/ml compared to 4% of CAC- firefighters (p,0.01). Conclusions: The prevalence of coronary calcium in Georgia compared to Monterey California firefighters is similar when adjusted for age and is approximately 35% in firefighters over the age of 40 years. Laboratory Measures of insulin resistance were significantly greater in Monterey firefighters with CAC+ and similar to the reported results in Georgia firefighters. Firefighters vulnerable to CHD events can be identified and appro- priate treatment undertaken that protect firefighters and thus the public. 113 Lipoprotein (a) levels and Risk of Cardiovascular Disease Events in Diabetes Mellitus and Prediabetes: The Atherosclerosis Risk in Communities Study Anum Saeed, MD, Anandita Agarwala, MD, Wensheng Sun, MS, MPH, Salim Virani, MD, PhD, Vijay Nambi, MD, PhD, Josef Coresh, MD, PhD, Elizabeth Selvin, PhD, MPH, Eric Boerwinkle, PhD, Peter Jones, MD, Christie Ballantyne, MD, Ron Hoogeveen, PhD, (Houston, TX) Lead Author’s Financial Disclosures: None Study Funding: None Background/Synopsis: Elevated lipoprotein (a) [Lp(a)] is one of the most common hereditary dyslipide- mias. Recent data from large-scale prospective and genetic association studies suggest a causal role of Lp(a) in premature atherosclerosis in the general population. Dia- betes mellitus is also known to confer a spectrum of elevated risk for incident cardiovascular disease (CVD). Currently, persons with diabetes are stratified for their CVD risk according to the ASCVD pooled cohort equation but there is no recommendation to screen them for elevated Lp(a) levels. Objective/Purpose: We examined the association of Lp(a) levels with incident CVD in persons with and without Table: Association of per quintile Lipoprotein (a) levels and Incident CVD events by Hazard Ratios and Incidence Rates (Event/ 1000 person-year), in Individuals with Normal Fasting Glucose, Pre-Diabetes and Diabetes Mellitus. Quintiles Q1 Q2 Q3 Q4 Q5 P-trend Lp(a) range (mg/dL) 0.2524.1 4.229.0 9.1218.9 19249.1 49.22226.6 Fasting Glucose ,100 mg/dL (n54713) HR (95% CI) IR Ref 10.2 0.90 (0.7121.16) 8.9 0.94 (0.7421.20) 9.8 0.99 (0.7721.26) 10.7 1.13 (0.8921.44) 11.2 0.44 Lp(a) range (mg/dL) 0.2523.9 4.028.7 8.8218.4 18.5244.9 452232.6 Fasting Glucose 1002125 mg/dL (n53615) HR (95% CI) IR Ref. 11.8 0.99 (0.7721.28) 12.7 1.16 (0.9021.49) 13.7 1.36 (1.0521.76) 14.2 1.33 (1.0321.72) 13.7 0.04 Lp(a) range (mg/dL) 0.25-3.6 3.7-9.2 9.3-23.1 23.2-49 49.3-216.7 Diabetes Mellitus (fasting glucose $ 125 mg/DL or diagnosis of diabetes) (n51543) HR (95% CI) IR Ref 26.4 0.92 (0.69-1.23) 23.1 0.94 (0.69-1.27) 21.5 1.24 (0.91-1.69) 27.3 1.37 (1.02-1.84) 32.4 0.03 Pooled Cohort Equation (PCE) models were applied for hazard ratio estimation in which the association of Lp(a) level and incident CVD was adjusted by age, gender, race, total cholesterol, HDL cholesterol, systolic blood pressure, anti-hypertensive medication user, baseline diabetes status, and current smoking. CVD events included CHD death; definite or probable MI, and coronary revascularization and ischemic stroke. Diabetes Mellitus defined by fasting glucose $126mg/dL or non-fasting glucose $200mg/dL or diabetes medication users; Pre-diabetes defined by impaired fasting glucose $100 and ,126mg/dL; Normal fasting glucose ,100mg/dL. Q5 Quintile; CVD5 Cardiovascular Disease; HR5Hazard Ratio; IR5 Incidence rate; CI 5 Confidence Interval. Abstracts 779