Lipoprotein(a) shows substantial longitudinal variability in children with type 1 diabetesDoes a child's heart risk marker change over time? New study finds surprising variability

medRxiv Published April 4, 2026 Study authors: Iafrate-Luterbacher, F.; Jimenez-Sanchez, C.; Anastasiadou, M. L.; Prados, J.; Renstroem, F.; Braend… DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Consider repeated Lp(a) assessment in youth with T1D due to substantial longitudinal variability.

A retrospective single-center cohort study followed 287 children and adolescents with type 1 diabetes at Geneva University Hospitals for a median of 6.2 years (IQR 2.9-9.6). The study aimed to characterize intra- and inter-individual trajectories of Lipoprotein(a) and assess implications for cardiovascular risk classification. No specific intervention or comparator was reported; the analysis focused on natural longitudinal variation.

At baseline, 26% of participants had elevated Lp(a) (≥300 mg/L). The main finding was substantial intraindividual variability: 32% of participants exhibited fluctuations exceeding 50% of their maximum Lp(a) value over time. This variability led to reclassification across the clinically relevant 300 mg/L threshold in 11.9% of the cohort. Lp(a) concentrations showed an age-related pattern, peaking between ages 10 and 13 years and declining thereafter. A modest but statistically significant seasonal variation was also observed, with higher levels in autumn and winter (P < 0.05).

Safety and tolerability data were not reported. Key limitations include the observational, single-center design, which cannot establish causality and may limit generalizability. The study did not report specific funding or conflicts of interest. For clinical practice, these findings suggest that relying on a single Lp(a) measurement in youth with type 1 diabetes may lead to misclassification of cardiovascular risk, particularly during the dynamic adolescent period when levels peak. Repeated assessment may be warranted for more accurate risk stratification.

When doctors check a child's risk for future heart problems, they often look at a blood marker called Lipoprotein(a), or Lp(a). For kids with type 1 diabetes, this number is especially important. But what if that number isn't a fixed score, but one that can bounce around? A new study followed 287 children and adolescents with type 1 diabetes at a Swiss hospital for a median of over six years. They found that Lp(a) levels were surprisingly changeable. About 32% of the kids had fluctuations where their levels swung by more than half of their maximum recorded value. Even more telling, nearly 12% of participants moved across a key medical threshold (300 mg/L) used to classify higher cardiovascular risk during the study period. The levels also seemed to follow a pattern, peaking between ages 10 and 13 before declining, and showing a modest seasonal uptick in autumn and winter. This is an observational study from a single medical center, so we can't say these fluctuations directly cause different health outcomes. But it raises a crucial question for families and doctors: if a risk marker can vary this much, does relying on one blood test give us the clearest picture? The findings suggest that repeated checks, especially during the turbulent adolescent years, might paint a more accurate portrait of a child's long-term heart health trajectory.

What this means for you:

A heart risk marker in kids with diabetes can change significantly, suggesting one test may not be enough.

Study Details

Study typeCohort

Sample sizen = 287

EvidenceLevel 3

PublishedMar 2026

View Original Abstract ↓

ContextLipoprotein(a) [Lp(a)] is a genetically determined and independent cardiovascular risk factor, traditionally considered stable across the lifespan, supporting a single lifetime measurement strategy. However, its longitudinal behavior during childhood and adolescence remains poorly characterized, particularly in individuals with type 1 diabetes who are at increased lifetime risk of cardiovascular disease. ObjectiveWe aimed to characterize intra- and inter-individual trajectories of Lp(a) in youth with type 1 diabetes and to assess the implications of variability for cardiovascular risk classification. MethodsWe conducted a retrospective single-center cohort study of children and adolescents with type 1 diabetes followed at Geneva University Hospitals between 2012 and 2023. Annual fasting Lp(a) concentrations were analyzed longitudinally. Variability was assessed in participants with more than two measurements. Clinically relevant thresholds were used to evaluate risk reclassification. Statistical analyses included paired Wilcoxon tests, Pearson and Kendall correlations, and Holm-adjusted p-values. ResultsA total of 287 participants contributed 1,408 Lp(a) measurements over a median follow-up of 6.2 years (IQR 2.9-9.6). At baseline, 26% had elevated Lp(a) (above or equal 300 mg/L). Among participants with serial measurements, 32% exhibited intraindividual fluctuations exceeding 50% of their maximum value. Reclassification across the 300 mg/L threshold occurred in 11.9% of participants. Lp(a) concentrations peaked between ages 10 and 13 years and declined thereafter. Modest seasonal variation was observed, with higher levels in autumn and winter (P < 0.05). ConclusionsIn youth with type 1 diabetes, Lp(a) demonstrates clinically relevant intraindividual variability over time. These findings suggest that reliance on a single lifetime measurement may lead to misclassification of cardiovascular risk and support repeated assessment, particularly during adolescence, to improve risk stratification.

Lipoprotein(a) shows substantial longitudinal variability in children with type 1 diabetesDoes a child's heart risk marker change over time? New study finds surprising variability

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Lipoprotein(a) shows substantial longitudinal variability in children with type 1 diabetesDoes a child's heart risk marker change over time? New study finds surprising variability

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