Children with High Lp(a)
Lp(a) is made of an LDL-like particle attached to an apolipoprotein. Like bad cholesterol (LDL), Lp(a) appears to increase the risk of cholesterol buildup in the arteries.
The (a) part of Lp(a) might increase the chance of clotting, but an important effect of high Lp(a) has to do with inflammation.
Lp(a) carries something called oxidized phospholipids. Those trigger inflammation and calcification of the aortic valve making it stiff. This leads to aortic stenosis.
Because Lp(a) isn’t measured with a standard cholesterol profile, many people don’t even know they have elevated levels.
Elevated Lp(a) is extremely common. It occurs in approximately 1 in 5 people around the world.
It’s tricky because it can be measured in two different ways.
If your Lp(a) is measured in mg/dl, a normal level is less than 30 and high is greater than 50. If your Lp(a) is measured in nmol/L, a normal level is less than 75 and high is greater than 125.
No, diet and exercise don’t change Lp(a) levels.
Your Lp(a) is determined by your genes. You inherit one “allele” (half of a gene) for Lp(a) from each of your parents. If you have high Lp(a), it’s likely that at least one of your parents has high Lp(a).
It’s also important to know that if you have elevated Lp(a), each time you have a child you have a 50/50 chance of passing it to them.
The first thing you should do is take a deep breath. Remind yourself that genetics are not your fault. You probably passed many wonderful traits on to your child.
You’re also living in a time of tremendous research on Lp(a). While there are not any Lp(a) lowering medications right now, there are several in clinical trials. You have knowledge, and knowledge is power.
One step you may want to discuss with your healthcare provider is getting your child’s LDL cholesterol levels to a safe and low number. This will decrease their risk in the long-term.
Another step you can take is to develop a healthy eating plan for your entire family. You can also make a family commitment to lifelong exercise.
In addition to a heart-healthy diet, if you’re a smoker, quit. This can be difficult, but quitting smoking is a gift to you and your children. Children model their parents, so one of the best ways to ensure your children are non-smokers, you should be a non-smoker.
Unfortunately, these changes won’t alter elevated levels of Lp(a). For now, if your child has elevated Lp(a) and normal LDL cholesterol, a healthy lifestyle is recommended.
Getting your child’s LDL to a safe area is important when they have high Lp(a). The American Academy of Pediatrics (AAP) and the National Lipid Association (NLA) recommend beginning cholesterol lowering medications between the ages of 9 and 11.
Statins are typically the first choice, and there are many available as generic medicines today.
If your child’s LDL is higher than 130 mg/dl, you might consider an additional medication. In this situation your child’s healthcare provider might suggest a bile acid sequestrant or ezetimibe.
If your child can’t reach their cholesterol goal with one medication, you should consider asking for a referral to a cholesterol/lipid specialist.
Children will typically have another visit to their healthcare provider 6 weeks after beginning medication. After that, they may need to be seen every 3 to 6 months.
It’s important that you have their blood tests done before the doctor’s appointment to ensure you can discuss the results with your healthcare provider.
This is very common. Teens and kids with high Lp(a) are like any other children, but obviously the stakes are higher.
It’s clearly frustrating to see your child’s eating habits get worse, but you have to pick your battles. Children will still be children.
The best thing you can do is set a good example. Make the foods you serve at home as healthy as possible and hopefully they will come around.