Lipoprotein (a): Examination of Cardiovascular Risk in a Pediatric Referral Population

Pediatric Cardiology volume 39, pages1540–1546(2018)Cite this article

Abstract

Atherosclerotic cardiovascular disease (CVD), a leading cause of death globally, has origins in childhood. Major risk factors include family history of premature CVD, dyslipidemia, diabetes mellitus, and hypertension. Lipoprotein (a) [Lp(a)], an inherited lipoprotein, is associated with premature CVD, but its impact on cardiovascular health during childhood is less understood. The objective of the study was to examine the relationship between Lp(a), family history of premature CVD, dyslipidemia, and vascular function and structure in a high-risk pediatric population. This is a single-center, cross-sectional study of 257 children referred to a preventive cardiology clinic. The independent variable, Lp(a), separated children into high-Lp(a) [Lp(a) ≥ 30 mg/dL] and normal-Lp(a) groups [Lp(a) < 30 mg/dL]. Dependent variables included family history of premature CVD; dyslipidemia, defined as low-density lipoprotein cholesterol > 130 mg/dL, high-density lipoprotein cholesterol (HDL-C) < 45 mg/dL, triglycerides (TG) > 100 mg/dL; and vascular changes suggesting early atherosclerosis, as measured by carotid–femoral pulse wave velocity (PWV) and carotid artery intima-media thickness (CIMT). Of the 257 children, 110 (42.8%) had high Lp(a) and 147 (57.2%) had normal Lp(a). There was a higher prevalence of African-American children in the high-Lp(a) group (19.3%) compared to the normal-Lp(a) group (2.1%) (p < 0.001). High Lp(a) was associated with positive family history of premature CVD (p = 0.03), higher-than-optimal HDL-C (p = 0.02), and lower TG (p < 0.001). There was no difference in PWV or CIMT between groups. High Lp(a) in children is associated with family history of premature CVD and is prevalent in African-American children. In children with high Lp(a), promotion of intensive lifestyle modifications is prudent to decrease premature CVD-related morbidity.

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Fig. 1

Published with permission of the Publisher. Reproduced with permission from Terrados et al. [11]. Copyright© 2010 Consell Català de l’Esport. Generalitat de Catalunya. Published by Elsevier Spain, S.L. All rights reserved

Fig. 2

Reproduced with permission from Springer Customer Service Centre GmbH: Springer Nature, by Omboni et al. [21] Copyright© 2016

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Funding

This study was supported by the Sarah Morrison Student Research Award at the University of Missouri-Kansas City School of Medicine (Kansas City, MO).

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Affiliations

  1. University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO, 64108, USA

    Omar Qayum, Noor Alshami & Chizitam F. Ibezim

  2. Children’s Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, USA

    Kimberly J. Reid, Janelle R. Noel-MacDonnell & Geetha Raghuveer

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  1. Omar Qayum
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  2. Noor Alshami
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  3. Chizitam F. Ibezim
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  4. Kimberly J. Reid
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  5. Janelle R. Noel-MacDonnell
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  6. Geetha Raghuveer
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Contributions

OQ: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision. NA: acquisition of data, analysis and interpretation of data. CFI: acquisition of data, analysis and interpretation of data. KJR, MS: analysis and interpretation of data, critical revision. JN-M, PhD: analysis and interpretation of data, critical revision. GR, MD: study conception and design, analysis and interpretation of data, drafting of manuscript, critical revision, project supervision. All authors reviewed, discussed, and approved the final manuscript submission.

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Correspondence to Omar Qayum.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Qayum, O., Alshami, N., Ibezim, C.F. et al. Lipoprotein (a): Examination of Cardiovascular Risk in a Pediatric Referral Population. Pediatr Cardiol 39, 1540–1546 (2018). https://doi.org/10.1007/s00246-018-1927-3

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Keywords

  • Lipoprotein (a)
  • Dyslipidemia
  • Pulse wave velocity
  • Carotid artery intima-media thickness
  • Premature cardiovascular disease