High Lp(a) in youth (ages 9-24) doubles the risk of adult cardiovascular disease decades later, pooled data from the Young Finns Study and Bogalusa Heart Study (Circulation 2023)

Original title: Lipoprotein(a) in Youth and Prediction of Major Cardiovascular Outcomes in Adulthood

Circulation · 28 November 2022 · 8

Raitakari O, Kartiosuo N, Pahkala K, Hutri-Kähönen N, Bazzano LA, Chen W, Urbina EM, Jacobs DR, Sinaiko A, Steinberger J, Burns T, Daniels SR et al.

Lp(a) measured in youth (ages 9-24) in the Cardiovascular Risk in Young Finns Study (YFS) was linked to adult atherosclerotic cardiovascular disease (ASCVD) and carotid intima-media thickness; 95 of the original 3,596 YFS participants (2.7%) developed ASCVD by a median age of 47 years. Youth exposure to high Lp(a) (>=30 mg/dL) was associated with about twice the risk of adult ASCVD in YFS (HR 2.0, 95% CI 1.4-2.6), findings replicated in White participants of the Bogalusa Heart Study (587 individuals, 15 cases; HR 2.4-2.5 after adjustment), and in pooled analysis across both cohorts (HR 2.0, 95% CI 1.0-3.7). No association was found between youth Lp(a) and adult carotid intima-media thickness in either cohort. The findings establish elevated Lp(a) measured in childhood or adolescence as a long-term risk factor for adult cardiovascular disease, independent of LDL cholesterol and BMI.

Original abstract

Background: Elevated lipoprotein(a) [Lp(a)] is a common risk factor for cardiovascular disease outcomes with unknown mechanisms. We examined its potential role in identifying youths who are at increased risk of developing adult atherosclerotic cardiovascular disease (ASCVD).

Methods: Lp(a) levels measured in youth 9 to 24 years of age were linked to adult ASCVD and carotid intima-media thickness in the YFS (Cardiovascular Risk in Young Finns Study), in which 95 of the original 3596 participants (2.7%) recruited as children have been diagnosed with ASCVD at a median of 47 years of age. Results observed in YFS were replicated with the use of data for White participants from the BHS (Bogalusa Heart Study). In BHS, 587 White individuals had data on youth Lp(a) (measured at 8-17 years of age) and information on adult events, including 15 cases and 572 noncases. Analyses were performed with the use of Cox proportional hazard regression.

Results: In YFS, those who had been exposed to high Lp(a) level in youth [defined as Lp(a) ≥30 mg/dL] had ≈2 times greater risk of developing adult ASCVD compared with nonexposed individuals (hazard ratio, 2.0 [95% CI, 1.4-2.6]). Youth risk factors, including Lp(a), low-density lipoprotein cholesterol, body mass index, and smoking, were all independently associated with higher risk. In BHS, in an age- and sex-adjusted model, White individuals who had been exposed to high Lp(a) had 2.5 times greater risk (95% CI, 0.9-6.8) of developing adult ASCVD compared with nonexposed individuals. When also adjusted for low-density lipoprotein cholesterol and body mass index, the risk associated with high Lp(a) remained unchanged (hazard ratio, 2.4 [95% CI, 0.8-7.3]). In a multivariable model for pooled data, individuals exposed to high Lp(a) had 2.0 times greater risk (95% CI, 1.0-3.7) of developing adult ASCVD compared with nonexposed individuals. No association was detected between youth Lp(a) and adult carotid artery thickness in either cohort or pooled data.

Conclusions: Elevated Lp(a) level identified in youth is a risk factor for adult atherosclerotic cardiovascular outcomes but not for increased carotid intima-media thickness.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.