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

Background 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 genetically determined, but newer literature suggests variation. This study investigated Lp(a) levels and their relationship with hemoglobin A1c (HgbA1c) in children with incident diabetes mellitus (DM). Design/Methods Children and adolescents aged 5-18 years with incident DM had baseline Lp(a) and lipid profiles. Repeat Lp(a) and HgbA1c were obtained three months later. Descriptive statistics (frequencies, proportions, means, medians) and non-parametric tests (Spearman correlation, Wilcoxon rank-sum/Kruskal-Wallis) were utilized. Statistical significance was set at p<0.05. 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 (13-73.7) nmol/L, 17 of which were elevated (>75 nmol/L). Of the 22 with follow-up, 8 were abnormal: 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 HgbA1c (p=0.004). Conclusions Children with DM have abnormal Lp(a) levels at a prevalence of ∼20% so this should be considered in CVD risk stratification. Further, observed Lp(a) fluctuations suggest value in serial Lp(a) assessments due to non-genetic influences. Without Lp(a) quantification, CVD risk characterization in children with DM may be inaccurate and should be considered for a comprehensive assessment.Introduction