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Lipoprotein(a) Concentrations Correlate With LDL-C in Children With Type 1 and 2 Diabetes
Christy Foster1, A K M Fazlur Rahman2, Ambika P Ashraf1
1Division of Pediatric Endocrinology, Department of Pediatrics, University of Alabama School of Medicine, Birmingham, AL 35233, USA.
Insights
Elevated lipoprotein(a) (Lp[a]) levels in children with diabetes are linked to low-density lipoprotein cholesterol (LDL-C) and race. Black children with diabetes show a higher burden of Lp[a] compared to White children.
Area of Science:
- Pediatric Endocrinology
- Cardiovascular Risk Factors
- Metabolic Disorders
Background:
- Elevated lipoprotein(a) (Lp[a]) is a significant, independent risk factor for atherosclerotic cardiovascular disease, particularly in diabetic populations.
- Lp[a]) levels in adulthood are established early in life, with adult levels typically expressed by the second year of life.
Purpose of the Study:
- To investigate the influence of low-density lipoprotein cholesterol (LDL-C), race, and HbA1c on lipoprotein(a) (Lp[a]) levels in pediatric patients with diabetes.
- To examine the relationship between Lp(a) and key metabolic and demographic factors in adolescents with type 1 and type 2 diabetes.
Main Methods:
- Retrospective electronic medical record review of 700 children and adolescents (ages 12-19) diagnosed with type 1 diabetes (T1D) (n=607) and type 2 diabetes (T2D) (n=93).
- Analysis included assessment of Lp(a) levels in relation to LDL-C, BMI, race, and HbA1c levels.
Main Results:
- Black children exhibited a significantly increased relative risk (RR) of higher Lp(a) compared to White children (RR 1.25, P < .0001).
- In T1D patients, higher LDL-C was associated with increased Lp(a) (5 mg/dL increase in LDL-C correlated with 2% increase in Lp[a], P < .0001).
- Both LDL-C (RR=1.02, P < .001) and BMI (RR=0.98, P < .001) were independently associated with Lp(a) levels.
Conclusions:
- Lipoprotein(a) (Lp[a]) levels are significantly associated with LDL-C in pediatric diabetic populations.
- Lp(a) concentrations increase differentially with higher LDL-C levels.
- Black children with diabetes face a substantial burden of elevated Lp(a) compared to their White counterparts, highlighting potential racial disparities in cardiovascular risk.
Context:
Elevated levels of lipoprotein(a) (Lp[a]) is an independent risk factor for atherosclerotic cardiovascular disease especially in patients with diabetes. Adult levels of Lp(a) are thought to be is expressed by the second year of life.
Objective:
We hypothesized that Lp(a) would be influenced by low density lipoprotein cholesterol (LDL-C), race, and HbA1C.
Methods:
Retrospective electronic medical record review of children and adolescents with type 1 diabetes (T1D) (n = 607) and type 2 diabetes (T2D) (n = 93).
Results:
Total of 700 subjects, ages 12-19 years with T1D (n = 607) and T2D (n = 93), 49% were male, mean age was 13.2 ± 3.08 years, and the median Lp(a) was 8.00 mg/dL, IQR 5.00-12.00. The Black subjects had an increased relative risk (RR) of higher Lp(a) compared with White subjects (RR 1.25, P < .0001). Among patients with T1D, Black people had an increased relative risk of higher Lp(a) than White people (RR 1.23, P = .0002). In T2D, Black subjects have 43% higher risk of having elevated Lp(a) than White subjects (RR 1.43, P = .268). In T1D, a 5 mg/dL increase in LDL-C results in 2% increase in Lp(a) (P < .0001). In T2D, a 5 mg/dL increase of LDL-C results in an increase of Lp(a) by 3%. LDL-C and BMI are independently associated with Lp(a) (RR = 1.02, P < .001; RR = 0.98, P < .001).
Conclusion:
Our data suggest that Lp(a) is associated with LDL-C in children with diabetes. Lp(a) is differentially increased at higher concentrations of LDL-C. Black children with diabetes have a significant burden of Lp(a) concentrations compared with White children.
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