Cardiovascular Disease

Childhood Lp(a) Predicts Adult CVD Risk

Individuals who had high Lp(a) levels when they were young were twice as likely to develop atherosclerotic cardiovascular disease in middle age, a new study in Circulation reveals

Lp(a) levels are almost entirely genetic (as opposed to being dictated by lifestyle choices), and this new study underscores the value of measuring Lp(a) in childhood, rather than waiting till middle age to identify those most at-risk.

The authors examined Lp(a) data from the 1970s YFS study (n=3596), which investigated the determinants of CV disease in Finnish children, as well as data from the 1980s Bogalusa Heart Study (n=587) out of Tulane University.  

In the YFS analysis, the authors found that…

  • Those with high childhood Lp(a) levels (defined as 30 mg/dL or higher) were about twice as likely to develop adult ASCVD (hazard ratio: 2.0).
  • The risk of coronary heart disease and noncoronary atherosclerotic events were both similarly increased.

In the BHS analysis, researchers found that…

  • Individuals with high childhood Lp(a) were 2.5 times more likely to develop adult ASCVD.
  • The risk associated with Lp(a) remained the same, even after adjusting for BMI and LDL-C.

In neither study was Lp(a) in youth associated with increased carotid artery thickness in adulthood, which may suggest that elevated Lp(a) levels do not confer CV risk by contributing to early preclinical vasculopathy.

The generalizability of these findings is unclear. The results observed in the Finnish study were replicated with data exclusively from White participants in the BHS “because the original YFS included only White participants.” Cardiovascular risk is known to differ across racial/ethnic groups, causing risk equations to consistently underperform in Black adults. So take these findings with a grain of salt.  

The Takeaway

Elevated Lp(a) is a known atherosclerotic CVD risk factor, and these data suggest that measuring Lp(a) in youth would help identify individuals at higher risk for future ASCVD. Although Lp(a) levels cannot be modified by lifestyle or diet, it appears to be important to emphasize heart-healthy lifestyle choices if elevated levels are detected during childhood.

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