Genetics
Girls with genetic FH have 45% higher baseline Lp(a) than boys, a sex gap that persists over nearly nine years of follow-up (Atheroscler Plus 2024)
Original title: Lipoprotein(a) in children and adolescents with genetically confirmed familial hypercholesterolemia followed up at a specialized lipid clinic
This retrospective study at the Lipid Clinic, Oslo University Hospital, reviewed 438 subjects with heterozygous familial hypercholesterolaemia (FH) who began follow-up before age 19, including 386 with at least one Lp(a) measurement (mean baseline age 13.8 years, similar between sexes). Girls had significantly higher baseline Lp(a) than boys (median 223 vs. 154 mg/L, p < 0.01). Over a mean 8.9-year follow-up, Lp(a) rose in both sexes, by a mean 151.4 mg/L (44.8%) in girls and 66.8 mg/L (50.5%) in boys, though neither the absolute nor percentage sex difference in change reached statistical significance (both p > 0.05). Lp(a) levels rise with age in children with genetic FH, and are consistently higher in girls than boys from an early age, a sex disparity that could influence future ASCVD risk assessment and the potential future role of Lp(a)-lowering therapy in this population.
Original abstract
Background And Aim: Many children with an FH mutation also exhibit elevated lipoprotein(a) levels, which is an independent risk factor for atherosclerotic cardiovascular disease. Studies have reported higher levels of lipoprotein(a) in adult and middle-aged women than men. There is limited knowledge on the concentration and change of lipoprotein(a) levels in children with genetic FH, and therefore we investigated sex-differences in lipoprotein(a) level and change in lipoprotein(a) in girls and boys with genetically confirmed FH.
Methods: Medical records were reviewed retrospectively in 438 subjects with heterozygous FH that started follow-up below the age of 19 years at the Lipid Clinic, Oslo University Hospital in Norway, and of these we included 386 subjects with at least one Lp(a) measurement.
Results: Mean (SD) age at baseline was 13.8 (7.3) years and the age was similar between sexes. Girls had a higher lipoprotein(a) level than boys at baseline: median (25-75 percentile) 223 (108-487) vs. 154 (78-360) mg/L, respectively (p < 0.01). From baseline to follow-up measurement (mean [SD] 8.9 [6.1] years apart), the mean (95 % CI) absolute and percentage change in Lp(a) level in girls was 151.4 (54.9-247.8) mg/L and 44.8 (16.4-73.1) %, respectively, and in boys it was 66.8 (22.9-110.8) mg/L and 50.5 (8.8-92.3) %, respectively (both p > 0.05).
Conclusions: We found an increase in Lp(a) levels in children with genetic FH with age, and higher levels in girls than boys, which could impact risk assessment and future ASCVD. Further research is needed to elucidate whether subjects with FH could benefit from lipoprotein(a)-lowering therapies that are under current investigations.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.