Childhood lipoprotein profiles and implications for adult coronary artery disease: the Bogalusa Heart Study.

Serum lipoproteins are important risk factor variables for coronary artery disease (CAD). Studies of a large population of young individuals show changes in lipoproteins in childhood are race- (black-white) and sex-specific and certain changes occur during growth phases. White boys show adverse changes in lipoprotein levels during sexual maturation that mark them at high risk for CAD. Further, low-density lipoprotein particles are relatively apolipoprotein B enriched in white children, especially boys, a characteristic associated with low levels of high-density lipoprotein cholesterol. The impact of apolipoprotein E genotype on serum lipoproteins seen in adults is already apparent in children, which may be helpful in identifying a high-risk group. Observations of child-parent associations in terms of parental myocardial infarction and levels of lipoprotein variables in the offspring suggest that childhood profiles of lipoprotein (a), apolipoprotein A-I, and apolipoprotein B may be helpful as markers of future CAD. Clustering of increased levels of truncal fat, insulin, and blood pressure is often seen in young adults with an adverse lipoprotein profile. This clustering is related to subtle abnormalities in carbohydrate and lipid metabolism and obesity in childhood. The fact that lipoprotein levels persist from childhood to young adulthood underscores the importance of detection and management of dyslipidemia early in life.