Lipoprotein(a) in atherosclerotic cardiovascular disease, type 2 diabetes, and liver disease

Background: Lipoprotein(a) is a unique, atherogenic glycoprotein that was reported in humans more than six decades ago and is an independent risk factor for atherosclerotic cardiovascular disease, including myocardial infarction and stroke. Aim of review: The purpose of this article is to review lipoprotein(a) biology, associations with disease, treatment, and potential value of screening in pediatrics. Key scientific concepts of review: Lipoprotein(a) has a lipid-rich core which contains triglycerides and cholesterol esters surrounded by a phospholipid shell containing an apolipoprotein B100 covalently bound to apolipoprotein (a). Lipoprotein(a) levels increase from birth to age two years and remain stable afterward. Lipoprotein(a) has a six-fold greater association with coronary heart disease than low-density lipoprotein. Type 2 diabetes may be associated with obesity, metabolic dysfunction, and vascular endothelial inflammation, but low lipoprotein(a) levels. In children, there is no association between lipoprotein(a) levels and obesity. Metabolic dysfunctionassociated steatotic liver disease may be associated with obesity, metabolic syndrome, diabetes, hypertension, metabolic dysfunction-associated steatohepatitis, hepatic fibrosis, and hepatocellular carcinoma. Patients with metabolic dysfunction-associated steatotic liver disease and low lipoprotein(a) levels may be more likely to develop hepatic fibrosis. Lipoprotein(a) levels may be decreased with some proprotein convertase subtilisin/ kexin type 9 inhibitors, small interfering RNAs, and antisense oligonucleotides and lipoprotein apheresis, but not statin drugs. Universal pediatric lipoprotein(a) screening is being considered because it may predict atherosclerotic cardiovascular disease in adulthood.