Highlights
- •Children with familial hypercholesterolemia (FH) and family history of early atherosclerotic cardiovascular disease were more likely to have high lipoprotein(a) [Lp(a)].
- •In FH, a child's Lp(a) was more predictive than peak low-density lipoprotein cholesterol for family history of early atherosclerotic cardiovascular disease.
- •Lp(a) level in children with FH may help risk stratify when family history is limited.
- •Lp(a) level may identify children with FH that could benefit from more aggressive management.
Background
Low-density lipoprotein cholesterol (LDL-C) level and lipoprotein(a) [Lp(a)] ≥ 50 mg/dL
predict atherosclerotic cardiovascular disease (ASCVD) risk in adults with familial
hypercholesterolemia (FH), but their role for children with FH is less clear.
Objective
This study examined the relationship between elevated Lp(a) and LDL-C levels in a
pediatric population with FH and onset of ASCVD in family members.
Methods
Retrospective review of pediatric patients with FH identified LDL-C, Lp(a), and family
history of ASCVD. Logistic regression modeling evaluated the association between the
child's Lp(a) and peak LDL-C level with earliest age of ASCVD onset in their family.
Results
One hundred twenty-nine children from 109 families were identified. Children from
families with early-onset ASCVD were 3 times more likely to have high Lp(a) than those
with a family history of late-onset ASCVD (OR: 3.77, 95% CI: 1.16–12.25, P = .027) but were not more likely to have highly elevated peak LDL-C (≥190 mg/dL)
(OR: 0.45, 95% CI: 0.11–1.80, P = .26).
Conclusion
Children with FH and family history of early-onset ASCVD were more likely to have
Lp(a) ≥50 mg/dL than children with FH and family history of late-onset ASCVD. Family
history of early-onset ASCVD was more predictive of a child's Lp(a) level than of
a child's peak LDL-C. Measurement of Lp(a) in children with FH may better characterize
their cardiovascular risk, particularly when knowledge of family history is limited.
Lp(a) testing may also identify children with FH that could benefit from more aggressive
management to reduce ASCVD risk.
Keywords
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Article info
Publication history
Published online: August 01, 2018
Accepted:
July 25,
2018
Received:
April 17,
2018
Identification
Copyright
© 2018 National Lipid Association. All rights reserved.
