Lipoprotein(a) and Family History of Cardiovascular Disease in Children.

Objective: increased lipoprotein(a) [Lp(a)] levels and family history of cardiovascular disease (CVD) represent emergent CVD risk factors. Aim of the study was to investigate the impact of lipid profile and Lp(a) on CVD family history. Methods: Lipid profile, Lp(a) levels and a two generation genealogical tree were evaluated among 231 children affected by familial dyslipidemias and 32 children showing only elevated Lp(a) levels. Lp(a) levels were stratified according to presence, age of occurrence, number and type of CVD in their kindreds. Results: Among 231 children affected by familial dyslipidemias lipoprotein and Lp(a) levels did not differ between children with or without family history of CVD. However, the percentage of children with elevated Lp(a) (85th percentile) was higher among those with a positive family history for early CVD (p=0.01). Lp(a) was a significant independent predictor of the number of premature cardiovascular events (β=0.17, p=0.01) and of cerebrovascular events in the kindreds (OR 2.5, 95% CI: 1.05-6.03, p=0.039), independent of plasma lipid fractions and other risk factors. Furthermore in the group of children showing only elevated Lp(a) levels a positive family history of CVD was detected in 85% families with an higher incidence of ischemic stroke alone or plus coronary heart disease (64.7%). Conclusion: the association between Lp(a) and family history of early CVD is due to a threshold effect among those with the highest Lp(a) levels. Furthermore multiple cardiovascular events and cerebrovascular events are significantly predicted by any increase in plasma Lp(a) levels, independent of other cardiovascular risk factors.