Lipoprotein(a) in children and adolescence

Lipoprotein(a) [Lp(a)], an LDL-like lipoprotein, has an additional carrier protein - apo (a), which closely resembles plasminogen. Epidemiological and experimental studies provide overwhelming evidence that Lp(a) may promote atherogenesis and thrombosis via its LDL-like and plasminogen-like mechanisms. With more than 90% variance explainable by the apo(a) gene, Lp(a) is detectable at birth and increases with age until adolescence when the Lp(a) reaches adult levels. There is a striking close offspring-parental correlation in Lp(a) levels, which is present at birth and tracks for life. While Lp(a) levels are highly regulated genetically and difficult to change, it appears that factors during the first year of life may have more impact on Lp(a) expression profiles, which possibly have long-lasting effects. Lp(a) levels are elevated in children with obesity, diabetes, renal diseases, hypercholesterolemia and are predictive of vascular diseases in themselves and other family members. We suggest that Lp(a) should be routinely measured in both children and adults for vascular disease risk factor assessment, at least among those with high conventional Coronary Artery Disease (CAD) risk factors and those with established CAD.