This case is submitted by Dr. Lisa Hudgins, Associate Professor of Pediatrics in Medicine, The Rogosin Institute/Weill Cornell Medical College:
I just saw 2 siblings with high Lp(a) referred by their father’s lipidologist. The medical history and physical exam are unremarkable in both children.
Father, 39, developed chest pain on exertion a year ago, quadruple bypass surgery. Lp(a) 470 (not sure whether mg/dL or nmol/L), a “slightly high” LDL-C and a “good LDL/HDL ratio”. Lean, avid jogger, no other risk factors. On high dose Crestor, to be monitored with CT angiography.
Paternal uncle, 42, cholesterol >300 (won’t get his Lp(a) checked)
Paternal grandfather, age 73, combined hyperlipidemia and (recently discovered) high Lp(a), coronary stents in his fifties.
Pt 1, male, age 5, TC 160, LDL-C 99, HDL-C 51, TG 52, Lp(a) 209 nmol/L (ULN 75)
Pt 2, female, age 3, TC 179, LDL-C 106, HDL-C 49, TG 120, Lp(a) 278 nmol/L
The parents were very anxious to do everything possible to prevent a rerun of Dad’s silent coronary disease in their children. They had 3 questions that I wish I had better answers to:
1) 1) What does the Lp(a) risk curve look like at the high extreme, specifically, should we consider doing a CT angiogram as early as the teen years?
2) 2) Should my daughter never take birth control pills?
3) 3) Will their children’s Lp(a) levels increase during adulthood?