Clinical Service for Dyslipidaemias, Study and Prevention of Atherosclerosis in Childhood, Paediatrics Unit, ASST-Santi Paolo e Carlo, 20142, Milan, Italy.
Centre for Paediatric Dyslipidaemias, Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121, Piacenza, Italy.
Atherosclerosis. 2022 May;349:233-239. doi: 10.1016/j.atherosclerosis.2022.04.021. Epub 2022 Apr 25.
Little is known about the role of Lp(a) in the assessment of cardiovascular risk in the paediatric population. Trying to clarify the clinical relevance of Lp(a) in risk stratification, the aim of the study is to evaluate the association between Lp(a) plasma levels in children with familial hypercholesterolaemia (FH) and positive family history for premature cardiovascular disease (pCVD) in first- and second-degree relatives.
653 Caucasian children and adolescents (334 females and 319 males), aged 2-17 years, with diagnosis of FH from a paediatric cohort included in the LIPIGEN Network, were selected. We compared family history of pCVD, lipid and genetic profile in two groups based on Lp(a) levels below or above 30 mg/dL. To determine the independent predictors of pCVD, a multivariate logistic regression was used, with all clinical characteristics and blood measurements as predictors.
Subjects with Lp(a) > 30 mg/dl more frequently reported positive family history of pCVD compared to subjects with Lp(a)≤30 mg/dl (69.90% vs 36.66%, p < 0.0001), while did not show differences in terms of median [interquartile range] LDL-cholesterol level (153.00 [88.00 vs 164.50 [90.25] mg/dL, p = 0.3105). In the regression analysis, Lp(a) > 30 mg/dl was an independent predictor of family history of pCVD. Comparing subjects with or without family history of pCVD, we reported significant differences for Lp(a) > 30 mg/dl (46.25% vs 17.65%, p < 0.0001), FH genetic mutation (50.48% vs 40.75%, p = 0,0157), as well as for LDL-cholesterol (p = 0.0013) and total cholesterol (p = 0.0101).
Children/adolescents with FH and Lp(a) > 30 mg/dl where more likely to have a positive family history of pCVD. Lp(a) screening in children and adolescents with FH may enhance risk assessment and help identify those subjects, children and relatives, at increased pCVD risk.
关于脂蛋白(a)在儿科人群心血管风险评估中的作用知之甚少。为了阐明脂蛋白(a)在风险分层中的临床相关性，本研究旨在评估家族性高胆固醇血症(FH)患儿脂蛋白(a)血浆水平与一级和二级亲属早发性心血管疾病(pCVD)阳性家族史之间的关系。
选择来自 LIPIGEN 网络儿科队列的诊断为 FH 的 653 名白种人儿童和青少年(334 名女性和 319 名男性)，年龄 2-17 岁。我们比较了 Lp(a)水平低于或高于 30mg/dL 的两组患者的 pCVD 阳性家族史、血脂和遗传特征。为了确定 pCVD 的独立预测因子，我们使用多元逻辑回归分析，将所有临床特征和血液测量作为预测因子。
与 Lp(a)≤30mg/dL 的患者相比，Lp(a)>30mg/dL 的患者更频繁地报告 pCVD 阳性家族史(69.90% vs. 36.66%，p<0.0001)，而 LDL-胆固醇中位数[四分位间距]并无差异(153.00[88.00 vs. 164.50[90.25]mg/dL，p=0.3105)。在回归分析中，Lp(a)>30mg/dL 是 pCVD 阳性家族史的独立预测因子。与有无 pCVD 阳性家族史的患者相比，我们报告了 Lp(a)>30mg/dL(46.25% vs. 17.65%，p<0.0001)、FH 基因突变(50.48% vs. 40.75%，p=0.0157)以及 LDL-胆固醇(p=0.0013)和总胆固醇(p=0.0101)的显著差异。
FH 患儿中 Lp(a)>30mg/dL 的患者更有可能存在 pCVD 阳性家族史。在 FH 患儿中进行 Lp(a)筛查可能会增强风险评估，并有助于识别那些具有增加 pCVD 风险的患者和亲属。
