Lipoprotein(a): a Case for Universal Screening in Youth

Area of Science:

• Cardiovascular Medicine
• Genetics
• Preventive Cardiology

Background:

• Lipoprotein(a) (Lp(a)) is a significant independent risk factor for atherosclerotic cardiovascular disease, stroke, and aortic stenosis.
• Current US guidelines do not include universal Lp(a) screening, leading to missed opportunities for early detection in at-risk families.
• Existing recommendations target specific high-risk adult and youth populations.

Purpose of the Study:

• To evaluate the feasibility and impact of incorporating Lp(a) measurement into routine universal lipid screening for youth.
• To highlight the potential for early identification of individuals and families at risk of cardiovascular disease.
• To advocate for updated screening guidelines to include Lp(a) measurement.

Main Methods:

• Lp(a) levels can be accurately measured in children from two years of age.
• Genetic determination of Lp(a) levels, inherited co-dominantly, with adult levels reached by age two.
• Assessment of the cost-effectiveness and feasibility of universal youth screening (ages 9-11 or 17-21).

Main Results:

• Serum Lp(a) levels are established by age two and remain stable throughout life.
• Novel targeted therapies for Lp(a) are under development, including antisense oligonucleotides and siRNAs.
• Universal Lp(a) screening in youth is feasible, cost-effective, and identifies at-risk individuals.

Conclusions:

• Universal Lp(a) screening in youth is a practical strategy to identify individuals at risk for ASCVD.
• This screening enables cascade family screening, facilitating early diagnosis and intervention for affected relatives.
• Implementing universal Lp(a) screening can significantly improve cardiovascular disease prevention efforts.