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Review

Lipoprotein (a) in Youth

In: Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000.
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Review

Lipoprotein (a) in Youth

Catherine J. McNeal et al.
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Excerpt

Lipoprotein (a) [Lp(a)] represents a class of lipoproteins with structural similarity to low-density lipoprotein (LDL). In adults, Lp(a) has been shown to be an independent risk factor in the development of atherosclerotic cardiovascular diseases (ASCVD) and calcific aortic valve disease (CAVD). Outcomes in youth are limited by the paucity of data but several studies suggest that it is a risk factor for arterial ischemic stroke (AIS). The usual pitfalls of extrapolating from adult data may be less problematic for Lp(a) given that the gene is fully expressed at a very young age and high levels in childhood are associated with elevated levels in adulthood, irrespective of pubertal development or lifestyle changes. Universal screening for elevated lipoprotein (a) is controversial, with some groups recommending universal screening and others advocating for selective screening. Regardless of strategy, screening is warranted given that the gene for Lp(a) is inherited as an autosomal co-dominant trait and is one the most heritable disorders in humans. We will review recent guideline-based evidence for Lp(a), the distribution and interpretation of the Lp(a) measurement, and pharmaceutical therapies to reduce Lp(a). We will also summarize the available evidence and recommendations regarding the detection and treatment of youth with elevated Lp(a). Although the relative merits of screening and treating Lp(a) in youth may be debatable, it is clear that youth who enter adulthood with the lowest possible burden of risk factors will have a much lower risk of developing ASCVD in adulthood. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG.

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