Management of hyperlipidemia in children

Atherosclerosis is a major cause of death and disability in adults. Recent investigations suggest that although cardiac end-points such as myocardial infarction and strokes mainly occur in middle-age and older subjects, the pathological basis for atherosclerosis begins in childhood. Hypercholesterolemia is one of the most important risk factors for atherosclerosis in adults and elevated cholesterol in children is associated with sub-clinical deposition of lipids in the aorta and coronary arteries. This report summarizes an approach to the diagnosis and treatment of hyperlipidemia in children. Based on guidelines from the National Cholesterol Education Program, children over 2 years of age should be screened for hypercholesterolemia if there is a family history of premature heart disease or hyperlipidemia. Therapy must be individualized. The majority of children with hyperlipidemia should be managed with a low-saturated fat and low-cholesterol diet. Children over 10 years of age with severe elevations of LDL-cholesterol and who come from high-risk families may be considered for more aggressive dietary therapy or medication in some cases. This is especially true for children with inherited disorders of lipid metabolism such as LDL-receptor deficiency. By identifying high-risk children and instituting therapy during childhood it is hoped that premature onset of adult coronary heart disease can be delayed or avoided altogether.