Age-Dependent Clinical Relevance of Lipoprotein(a): A Comprehensive Review from Childhood to Adulthood

Abstract

Lipoprotein(a) [Lp(a)] has emerged as a significant independent risk factor for atherosclerotic cardiovascular disease (ASCVD). While plasma Lp(a) levels remain relatively stable throughout life, their clinical impact varies depending on age and concentration. This comprehensive review examines the age-dependent clinical relevance of Lp(a), from childhood through adulthood. In pediatric populations, elevated Lp(a) levels are associated with early indicators of vascular dysfunction and with conditions like familial hypercholesterolemia (FH). In adults, elevated Lp(a) is consistently linked to an increased risk of myocardial infarction (MI), stroke, and calcific aortic valve disease, particularly in those with additional cardiovascular risk factors. We also discuss emerging therapies targeting Lp(a) that may significantly alter long-term cardiovascular risk if implemented early. Understanding the lifelong implications of elevated Lp(a) highlights the need for age-specific strategies for screening, monitoring, and intervention. Future research should prioritize identifying high-risk pediatric populations, refining risk thresholds, and determining optimal timing for therapeutic initiation to improve long-term cardiovascular outcomes.