ABSTRACT
LDL-C: low-density lipoprotein cholesterol; Fg: fibrinogen; Lp(a): lipoprotein(a) 10.4 CONCLUSION Atherosclerosis begins in childhood and progresses to CVD in adults (Groner et al., 2006). Many studies have shown that elevated levels of Lp(a) are associated with atherosclerotic disease, however, it is not known whether Lp(a) elevation can be regarded as an additional risk factor in children and adolescents. The lack of consistent methodologies and reference values indicates that we are hitherto unable to establish ‘normal’ or ‘at risk’ Lp(a) levels specific to the younger population. For this reason, a cut-off point that is frequently used in young people is the value associated with adults, namely, " 30 mg·dL-1. In this study, the distribution of Lp(a) levels was skewed towards the lower end, non-continuous, and over a broad range; this would explain the large standard deviation values reported. There was no significant difference between boys and girls, but 26% (n = 55) of the schoolchildren exceeded the published cut-off point for Lp(a). Of those schoolchildren identified as having elevated levels of Lp(a), 60% reported CVD in a close family member. Some clinicians challenge the need to measure Lp(a) as part of CVD risk assessment, particularly in the younger population, however, it is possible that Lp(a) is a risk factor worth screening for when considering the population's risk of CVD. Elevated levels of both Lp(a) and LDL-C are considered to have the greatest detrimental influence on health status (Sveger et al., 2000). In our cohort, two boys and one girl demonstrated this combination. This was similar to the value reported by Sveger and colleagues (2000) who found combined elevated levels of Lp(a) and LDL-C in 1.7% of children aged 10 to 11 years with a family history of CHD. The combination of Lp(a) and Fg was more common in our group of schoolchildren, with 15% exhibiting this unfavourable condition. In summary, the results of this study suggest that the early identification of individuals at increased CVD risk might be worthwhile. Although lifestyle interventions, including the modification of physical activity and eating habits, are not thought to have a significant effect on Lp(a) levels, they are known to affect LDL-C and Fg. If interventions are implemented sufficiently early in life, this might reduce the potential cardiovascular risk of elevated Lp(a) which, separately, is less amenable to lifestyle changes.
