Characterizing Lipoprotein(a) in Children With New-Onset Diabetes and Implications for Cardiovascular Risk Assessment.

Abstract

Context: Children with diabetes mellitus (DM) have an increased risk for cardiovascular disease (CVD), a risk potentially exacerbated by elevated lipoprotein(a) (Lp(a)). While other cholesterol parameters are screened in this population, Lp(a) is often overlooked despite being an independent CVD risk factor. Lp(a) levels are historically believed to not change over an individual's life and are genetically determined, but newer literature suggests variation.

Objective: This study investigated Lp(a) levels and their relationship with glycated hemoglobin A_1c (HbA_1c) in children with incident diabetes mellitus (DM).

Methods: Children and adolescents aged 5 to 18 years with incident DM had baseline Lp(a) and lipid profiles. Repeat Lp(a) and HbA_1c were obtained 3 months later. Descriptive statistics (frequencies, proportions, means, medians) and nonparametric tests (Spearman correlation, Wilcoxon rank-sum/Kruskal-Wallis) were used. Statistical significance was set at P less than .05.

Results: Seventy-six children were included for evaluation: 76% with type 1% and 23% type 2 DM. Baseline median (Q1-Q3) Lp(a) was 43.3 nmol/L (13-73.7 nmol/L), 17 of which were elevated (≥75 nmol/L). Of the 22 participants with follow-up, 8 were abnormal: A total of 4 whose baseline Lp(a) were abnormal remained so and 4 with normal levels became abnormal. A positive correlation was found between 3-month Lp(a) values and HbA_1c (P = .004).

Conclusion: Children with DM have abnormal Lp(a) levels at a prevalence of approximately 20%, so this should be considered in CVD risk stratification. Further, observed Lp(a) fluctuations suggest value in serial Lp(a) assessments due to nongenetic influences. Without Lp(a) quantification, CVD risk characterization in children with DM may be inaccurate and should be considered for a comprehensive assessment.