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The Apo A, B, a of coronary risk: back to kindergarten
D E Wilcken1, X L Wang, N P Dudman
1Department of Cardiovascular Medicine, University of New South Wales, Prince Henry/Prince of Wales Hospitals, Sydney, Australia.
Insights
Measuring apolipoproteins (Apo) B/A1 ratio and Apo(a) in childhood effectively identifies families with inherited lipid disorders and increased cardiovascular risk, enabling early intervention.
Area of Science:
- Cardiovascular Medicine
- Genetics
- Pediatrics
Background:
- Inherited lipid disorders affect ~1% of the population, increasing premature vascular disease risk.
- Apolipoproteins B (Apo B), A1 (Apo A1), and Apo(a) are key markers for dyslipidaemia and cardiovascular risk.
- Early detection in families is crucial for preventing inherited dyslipidaemia.
Purpose of the Study:
- To assess apolipoprotein changes in children during the first 12 years of life.
- To identify young families with inherited dyslipidaemia for early prevention strategies.
- To establish normal apolipoprotein values and identify cardiovascular risk markers in childhood.
Main Methods:
- Longitudinal measurement of apolipoproteins B, A1, and Apo(a) in 1032 infants (first week and 8.5 months).
- Assessment of apolipoprotein levels in 1400 school children (aged 8-12 years).
- Correlation analysis of infant and childhood apolipoprotein levels with parental values.
Main Results:
- Apo B/A1 ratio and Apo(a) levels tracked closely in infants (p < 0.01 and < 0.0001).
- High Apo B/A1 ratios identified familial hypercholesterolaemia; high Apo B identified hyperapolipoprotein B.
- Childhood Apo(a) levels correlated strongly with parental values (r=0.73, p<0.0001), indicating familial inheritance.
Conclusions:
- Measuring Apo B/A1 ratio and Apo(a) in childhood is a feasible method for identifying families at increased cardiovascular risk.
- Early identification facilitates timely intervention for inherited dyslipidaemia.
- Further assessment of the family-based coronary prevention programme's efficacy is warranted.
Abstract:
Approximately 1% of the population have a dominantly inherited lipid disorder predisposing to premature vascular disease. Apolipoproteins (Apo) B, and A1, the carrier proteins for the atherogenic low density lipoprotein (LDL) and the protective high density lipoprotein (HDL) cholesterol respectively are markers for these disorders, as is Apo(a), the unique carrier protein for lipoprotein(a). We assessed changes in these apolipoproteins during the first 12 years of life, aiming to detect young families with inherited dyslipidaemia and implement early prevention. Among 1032 consecutively born babies in whom levels were measured within their first week and at a mean age of 8.5 months, the Apo B/A1 ratio and Apo(a) both tracked closely (p < 0.01 and < 0.0001). High B/A1 ratios (> 95 percentile) identified two families with familial hypercholesterolaemia, and infants with high Apo B identified two families with hyperapolipoprotein B. Apo(a) levels increased twofold between the first week and 8.5 months and were highly correlated (r = 0.73, p < 0.0001). Levels at 8.5 months were not different from parental values and were closely correlated with them. We then assessed school children aged eight to 12 years. In a pilot study (n = 1400) we have established normal apolipoprotein values and distribution patterns and defined the 95th percentile for each. This study is continuing and parents of children with high levels are being recalled (with their children) for lipid measurements. Our findings indicate that our approach is feasible and has wide acceptance, and that measuring Apo B/A1 and Apo(a) in childhood identifies families at increased cardiovascular risk. We have yet to assess the efficacy of our family-based coronary prevention programme.