Lp(a) level increases during childhood

Lipoprotein(a) levels from childhood to adulthood: Data in nearly 3,000 children who visited a pediatric lipid clinic

Literature - De Boer LM, Hof MH, Wiegman A, et al. - Atherosclerosis. 2022 Mar 20; S0021-9150(22)00124-1. doi: 10.1016/j.atherosclerosis.2022.03.004

Introduction and methods

Background

According to clinical guidelines, Lp(a) measurement should be considered at least once in each person’s lifetime to identify those individuals with extremely elevated Lp(a) levels (≥180 mg/dL) and to improve cardiovascular risk assessment [1]. Lp(a) levels are measured only once based on the assumption they do not change with age nor vary within individuals [2,3], but long-term follow-up studies are lacking to confirm this. Also, data on Lp(a) levels are in adults, but it is unknown whether Lp(a) levels change during childhood.

Aim of the study

The authors evaluated whether Lp(a) levels change during childhood and if there is intra-individual variation.

Methods

This was a retrospective cohort study of 2740 children who visited the pediatric lipid clinic of the Amsterdam University Medical Center in Amsterdam, the Netherlands between June 1989 and October 2017 after referral for a tentative diagnosis of (inherited) dyslipidemia. Inclusion criterion was a first Lp(a) measurement before the age of 18 years, and exclusion criteria were lacking or incomplete Lp(a) measurement and PCSK9 inhibitor use during follow-up. All Lp(a) measurements were carried out by the same clinical laboratory of the Amsterdam UMC.

Main results

Association between Lp(a) levels and age

  • In children without lipid-lowering medication (n = 2254), mean Lp(a) level increased by 22% from age 8 to 20 years.
  • In children who were on statins (n = 418), mean Lp(a) levels increased by 43% from age 8 to 20 years.
  • In children who took statins and ezetimibe (n = 65), mean Lp(a) levels increased by 9% from age 8 to 20 years. Only in this group, Lp(a) levels first increased (until age 15 years), after which they seemed to stabilize.

Intra-individual variation

  • In 68% of the children, a change of ≥20% between two measurements was seen.
  • The intra-child variation in Lp(a) levels was 70%.

Conclusion

Lp(a) levels increased by 22% (no lipid-lowering medication) or 43% (statin use) from childhood into adulthood and varied markedly within children. The authors therefore recommend measuring Lp(a) levels at least twice during childhood and to repeat this in adulthood.

References

1. F. Mach, C. Baigent, A.L. Catapano, K.C. Koskinas, M. Casula, L. Badimon, et al., ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk, Eur. Heart J. 41 (1) (2019) 111–188, 2020.

2. J. Cegla, M. France, S.M. Marcovina, R.D.G. Neely, Lp(a): when and how to measure it, Ann. Clin. Biochem. 58 (1) (2021) 16–21.

3. D.P. Wilson, T.A. Jacobson, P.H. Jones, M.L. Koschinsky, C.J. McNeal, B. G. Nordestgaard, et al., Use of Lipoprotein(a) in clinical practice: a biomarker whose time has come. A scientific statement from the National Lipid Association, J Clin Lipidol 13 (3) (2019) 374–392.

Find this article online at Atherosclerosis

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