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High lipoprotein(a) concentrations are associated with impaired endothelial function in children
Jouni Lapinleimu1, Olli T Raitakari2, Helena Lapinleimu3
1Department of Medicine, University of Turku, Turku, Finland; Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Division of Medicine, TYKS Salo Hospital, Salo, Finland.
Insights
Familial high lipoprotein(a) (Lp(a)) is linked to reduced endothelial function in children. Early lifestyle interventions may help mitigate this association, promoting better cardiovascular health.
Area of Science:
- Cardiovascular Research
- Pediatric Health
- Endocrinology
Background:
- Lipoprotein(a) (Lp(a)) is an independent risk factor for cardiovascular disease.
- Familial hyperlipoproteinemia(a) can predispose children to early cardiovascular risks.
- Understanding Lp(a)'s impact on pediatric endothelial function is crucial for early intervention.
Purpose of the Study:
- To investigate the relationship between elevated familial lipoprotein(a) (Lp(a)) levels and endothelial function in children.
- To assess if early lifestyle interventions can modify the impact of high Lp(a) on vascular health.
- To analyze flow-mediated dilation (FMD) as a marker of endothelial function in relation to Lp(a) concentrations.
Main Methods:
- A randomized controlled trial involving 1062 families, with an intervention group receiving dietary counseling.
- Measurement of children's Lp(a) and lipid levels, with endothelial function assessed via brachial artery flow-mediated dilation (FMD) at age 11.
- Linear regression analyses were used to examine the association between FMD and Lp(a) in control and intervention groups, specifically in familial risk children.
Main Results:
- A significant inverse association was observed between Lp(a) concentration and FMD in control children and familial risk children.
- This association between Lp(a) and attenuated endothelial function was not significant in the intervention group.
- Children with very high Lp(a) (>500 mg/L) in the intervention group showed no attenuation in FMD, suggesting a protective effect of the intervention.
Conclusions:
- Familial high lipoprotein(a) concentration is associated with impaired endothelial function in children.
- Early lifestyle intervention appears to mitigate the negative effects of high Lp(a) on endothelial function.
- These findings highlight the importance of early intervention for children with familial hyperlipoproteinemia(a).
Objective:
To examine the association between familial high lipoprotein(a), or Lp(a), concentrations and endothelial function in children participating in the Special Turku Coronary Risk Factor Intervention Project study.
Study Design:
Seven-month-old children (n = 1062) with their families were randomized to a risk intervention group or to a control group. The intervention group received individualized dietary counseling to reduce the total cholesterol concentration. Children's Lp(a) and lipid values were measured repeatedly. At age 11 years, children were recruited to an ultrasound study of the flow-mediated dilation (FMD) of the brachial artery. The association between relative peak FMD and Lp(a) concentration was examined in 198 control and 193 intervention group children by linear regression analyses adjusted for sex, total cholesterol concentration, and basal artery diameter. The analyses were made in both the control and intervention groups and in the familial risk children who had a parent with Lp(a) concentration greater than 250 mg/l.
Results:
Lp(a) concentrations were similar at age 11 years in the intervention and control groups. In all control children, FMD (%) associated inversely with Lp(a) concentration: (β [%/1000 mg/L] = -3.74, 95% CI [-6.43, -1.45]; P = .007) and in 68 familial risk children (β = -4.92, 95% CI [-8.18, -1.66]; P = .0037). In the intervention group the associations were lacking (P > .5), and FMD in the children with high Lp(a) concentrations (>500 mg/L, n = 12) had no attenuation (P = .027).
Conclusions:
Familial high Lp(a) concentration is associated with attenuated endothelial function. This association may be mitigated by an early lifestyle intervention.
Trial Registration:
ClinicalTrials.gov: NCT00223600.
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