Lipoprotein(a) Concentrations Correlate With LDL-C in Diabetic Children

Cardiovascular disease (CVD) is a significant cause of mortality in those with diabetes. Increased apolipoprotein B (apoB) and low-density lipoprotein cholesterol (LDL-C) have been shown in pediatric patients with diabetes with worsening glycemic control.

Lipoprotein(a) (Lp(a)) is a highly atherogenic lipoprotein that attaches to the apoB 100 moiety of LDL-C particles. Lp(a) is concentration is generally fully expressed by the second year in childhood. Lp(a) is highly heritable, with great concordance between parental levels.

Pediatric Endocrinologists at the University of Alabama School of Medicine (Birmingham, AL, USA) investigate the relationships between serum concentrations of Lp(a) with low-density lipoprotein cholesterol (LDL-C), race, body mass index (BMI), and HbA1c in children with diabetes. Their secondary aim was to evaluate the factors associated with elevated Lp(a) levels. The carried out across-sectional retrospective chart review of pediatric patients, ages 12-19 years, including 607 type 1 diabetes (T1D) and 93 type 2 diabetes (T2D); 49% were male, mean age was 13.2 ± 3.08 years, and the median Lp(a) was 8.00 mg/dL. In addition to standard lipid profile testing, the clinical laboratory also offered Vertical Auto Profile (VAP) testing through a commercial laboratory (Atherotech, Birmingham, AL, USA).

The investigators reported that the Black children had an increased relative risk (RR) of higher Lp(a) compared with White ones (RR 1.25). The median Lp(a) was significantly higher in Black people than in White people, 9 (6-14) versus 7 (5-11). Among patients with T1D, Black people had an increased relative risk of higher Lp(a) than White people (RR 1.23). In T2D, Black participants have 43% higher risk of having elevated Lp(a) than White participants (RR 1.43). In T1D, a 5 mg/dL increase in LDL-C results in 2% increase in Lp(a). 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 and RR = 0.98), respectively. Interestingly, patients with T1D had higher mean levels of Lp(a) despite having a lower BMI compared to children with T2D. Patients with T1D had higher mean HbA1c than those with T2D (9.14% [5.88-12.4] versus 8.27% [5.67-10.87]).

The authors concluded that Lp(a) is strongly associated with LDL-C in children with diabetes, indicating a reduction of LDL-C may additionally reduce cardiovascular risk by lowering Lp(a) levels. Black children with diabetes have a significant burden of Lp(a) concentrations compared with White children. It may be important to consider Lp(a) screening in children with diabetes for disease risk management and implement stricter therapeutic goals for LDL-C reduction. The study was published in the November, 2021 issue of Journal of the Endocrine Society.

Related Links:
University of Alabama School of Medicine
Atherotech