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RESULTS

BACKGROUND

OBJECTIVE

METHODS

DISCUSSION

ACKNOWLEDGMENT

 

An elevated lipoprotein(a) [Lp(a)] level is prevalent in about 20% of the global population and has been regarded as a causal risk factor for cardiovascular disease (CVD). It is associated with atherosclerosis with a pro-thrombotic, pro-atherogenic, and pro-inflammatory effect. It has also been identified as an independent risk factor for coronary heart disease, stroke, and calcific aortic valve stenosis. Adult levels are achieved by about 5 years of age and may remain stable through an individual’s lifetime. In light of the mounting evidence of the role of Lp(a) in the development of CVD starting from a young age, it is pertinent to assess the association between Lp(a) and lipids levels in the pediatric population. However, in pediatric populations, higher Lp(a) levels have been associated with conflicting lipid levels [low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG)].

  • 271 medical charts of patients between 5 to 21 years old who underwent Lp(a) testing at Northwell Health from January 2014 to June 2022 were reviewed retrospectively. Cases were identified by searching the Allscripts, Cohen Children Medical Center (CCMC) carotid ultrasound, syngo Dynamics echocardiogram, stress test, and CCMC Lipid Center databases. In addition, Health Catalyst relational “Population Builder” and the Northwell Health Laboratory Services database were utilized in collaboration with the Northwell Laboratory informatics team.
  • Exclusion criteria: Patients who did not have both Lp(a) and total cholesterol (TC) results.
  • Statistical analysis: Descriptive and summary statistics were presented for each variable. Chi-square, Wilcoxon rank-sum, and t-tests were performed.
  • The correlation between Lp(a) levels of lipid of study participants was assessed using the following algorithm.

Lipids

Normal Abnormal

Normal

Lp(a)

Abnormal

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Definition of abnormal levels:

Lp(a) > 100 nmol/L

TC ≥ 200 mg/dL; TG ≥ 150 mg/dL

HDL-C < 40 mg/dL, and LDL-C ≥ 130 mg/dL.

  • High Lp(a) levels were seen in patients with normal LDL-C and TC levels.
  • Patients with a high Lp(a) level were more likely to have higher HDL-C levels. Although statistically significant, the finding is unlikely to be clinically significant.
  • The was no correlation between the patient’s BMI and high Lp(a).
  • When comparing the findings to past studies, our finding of the association between high Lp(a) levels and higher HDL-C levels was consistent with findings from previous studies 1,2.
  • No significant associations of high Lp(a) with TG were found2,3. However, many previous studies did find an association between high Lp(a) and LDL-C, TC, and TG1,4-6.

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  • Future CVD risk may be underestimated in patients with normal TC, LDL-C, and/or BMI levels.
  • Current United States lipid screening guidelines do not include Lp(a) and may benefit from the inclusion of Lp(a)

in the routine lipid panel.

  • Future multicenter studies are recommended to examine the association between Lp(a), lipid levels, and CVD risk in the pediatric population.

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  • Of 241 patients, 111 (46%) were female
  • 38 (16%) had high Lp(a) levels, 68 (28%) had abnormal TC levels, 35 (15%) had abnormal TG levels, 41 (17%) had abnormal HDL-C levels, and 62 (26%) had abnormal LDL-C levels.
  • Of 173 with normal TC levels, 25 (14.5%) had a high Lp(a)
  • Of 178 with normal LDL-C levels, 26 (14.6%) had a high Lp(a)
  • Of 68 with abnormal TC levels, 55 (80.9%) had a normal Lp(a)
  • Of 62 with abnormal LDL-C levels, 50 (80.6%) had a normal Lp(a).
  • High Lp(a) was only found to be significantly associated with HDL-C.
  • The mean HDL-C was higher among those with high Lp(a) compared to those with normal Lp(a) (55.8 ± 13.4 vs. 50.7 ± 12.2; p= 0.022).

This study aimed to elucidate the association of Lp(a) with normal and abnormal lipid profiles and to evaluate current practices in screening for Lp(a) in the investigators’ home institution.

Normal Lipids, Normal Lp(a)

Abnormal Lipids, Normal Lp(a)

Normal Lipids,

Abnormal Lp(a)

Abnormal Lipids,

Abnormal Lp(a)

A Single-Center Retrospective Study Of Lipoprotein(a) And Lipid Levels In A Pediatric Population

Cocorpus, J1, Shamailova, O1, Gruber, D1,2, Salemi, P3, Fishbein J4, Talib, R5, Ziemba, Y6, Schleicher, C.B7, Crawford, J. M6, Shapir, Y1,8, Hirsh, B9, Nwosu, B3, Cooper, R.S.1,8

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1 Pediatric Cardiology, Cohen Children’s Medical Center, New Hyde Park, NY, 2 Departments of Pediatrics and Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead New York, USA

, 3Pediatrics/Pediatric Endocrinology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, 4Biostatistics, Feinstein Institutes for Medical Research, New Hyde Park, NY, 5Pediatric Endocrinology, Cohen Children’s Medical Center, New Hyde Park, NY, 6Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, 7IT Strategy, Northwell Health, Lake Success, NY, 8Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, 9Cardiology, North Shore University Hospital, Great Neck, NY.

LIMITATIONS

Limitations of our study include a small sample size.

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1. Qayum, O., et al., Lipoprotein (a): Examination of Cardiovascular Risk in a Pediatric Referral Population. Pediatr Cardiol, 2018. 39(8): p. 1540-1546.

2. Sharma S, Merchant J, Fleming SE. Lp(a)-cholesterol is associated with HDL-cholesterol in overweight and obese African American children and is not an independent risk factor for CVD. Cardiovasc Diabetol, 2012. 11:10.

3. Gannagé-Yared MH et al., Prevalence and status of Lipoprotein (a) among Lebanese school children. Sci Rep, 2020. 10(1):20620.

4. Rodríguez-Moran, M., et al., Lipoprotein(a) and Hyperinsulinemia in Healthy Normal-weight, Prepubertal Mexican Children. Endocr Res, 2021. 46(3): p. 87-91.

5. Gannagé-Yared, M.H., et al., Prevalence and status of Lipoprotein (a) among Lebanese school children. Sci Rep, 2020. 10(1): p. 20620.

6. Schmidt, K., et al., Genetics of the Lp(a)/apo(a) system in an autochthonous Black African population from the Gabon. Eur J Hum Genet, 2006. 14(2): p. 190-201.

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(Overall N=241)

Mean

(Min-Max)

Age (years)

15.7 (6.0 – 23.0)

BMI (kg/m2)

23.1 (13.7 – 51.8)

Lp(a) (nmol/L)

58.0 (9.0 – 836.7)

TC (mg/dL)

180.4 (95.0 – 443.0)

TG (mg/dL)

102.8 (29.0 – 694.0)

HDL (mg/dL)

51.5 (25.0 – 89.0)

LDL (mg/dL)

109.5 (42.0 – 350.0)

non-HDL (mg/dL)

127.5 (51.0 – 341.0)

TC/HDL Ratio

3.7 (1.8 – 12.7)

Table 1. Demographic and clinical

characteristics of pediatric patients

Variable

Normal Lp(a)

Abnormal Lp(a)

P-value

TC (mg/dL)

178.2 (+53.5)

192.3 (+47.6)

0.13

HDL (mg/dL)

50.7 (+12.2)

55.8 (+13.4)

0.02

LDL (mg/dL)

107.8 (+49.8)

118.0 (+43.2)

0.2

Table 3. The correlation between normal and abnormal Lp(a) and lipid levels

Graph 1. Distribution of HDL by High Lp(a)

Thank you to the CCMC Department of Pediatrics, Division of Pediatric Cardiology and Endocrinology, the Feinstein Institutes for Medical Research, IT, and the Departments of Pathology and Adult Cardiology at Northwell Health.

(Overall N=241)

N (%)

Female

111 (46.1%)

Black

26 (10.8%)

Hispanic

22 (9.1%)

White

92 (38.2%)

Other

123 (51.0%)

Age (years)

16.0 (6.0, 23.0)

High Lp(a)

38 (16%)

Taking Statins

19 (7.9%)

Family History of Cardiovascular Event in a First Degree Relative

72 (29.9%)

Table 2. Lipid profile of the study population

CONCLUSION

References

*TG (mg/dL) and the TC/HDL ratio were compared with a Wilcoxon rank-sum test and were not considered significant (p = 1.0)

**p<0.05 is considered significant

*Normal (Lp(a) ≤ 100 nmol/L) = 50.0 (42.0 – 59.0) and Abnormal (Lp(a) > 100 nmol/L) = 56.0 (46.0 – 61.0), p = 0.02

p= 0.02

About Northwell Health

Northwell Health is New York State’s largest health care provider and private employer, with 22 hospitals, over 550 outpatient facilities and nearly 15,000 affiliated physicians. We care for more than two million people annually in the New York metro area and beyond, thanks to philanthropic support from our communities. Our 63,500 employees – 15,000+ nurses and over 4,000 employed doctors, including members of Northwell Health Physician Partners – are working to change health care for the better. We’re making breakthroughs in medicine at the Feinstein Institute. We're training the next generation of medical professionals at the visionary Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies. For information on our more than 100 medical specialties, visit Northwell.edu.

About Northwell Health

Northwell Health is New York State’s largest health care provider and private employer, with 22 hospitals, over 550 outpatient facilities and nearly 15,000 affiliated physicians. We care for more than two million people annually in the New York metro area and beyond, thanks to philanthropic support from our communities. Our 63,500 employees – 15,000+ nurses and over 4,000 employed doctors, including members of Northwell Health Physician Partners – are working to change health care for the better. We’re making breakthroughs in medicine at the Feinstein Institute. We're training the next generation of medical professionals at the visionary Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies. For information on our more than 100 medical specialties, visit Northwell.edu.