Hyperlipidemia in adolescents

Coronary artery disease is the leading cause of morbidity and mortality in the United States. Studies increasingly indicate that atherosclerotic lesions are evident in the vasculature by late adolescence, and that hyperlipidemias are a common and remediable contributor to their development. Hence, health care providers dealing with adolescents must be familiar with contemporary concepts about the etiology, classification, and management of hyperlipidemias in children and adolescents. This chapter briefly reviews lipid metabolism, emphasizing lipoprotein composition, key components, enzymes, cellular receptors, transport, uptake, and fate. This framework provides a rational classification with exclusion and treatment of secondary causes such as obesity, poorly controlled diabetes, hypothyroidism, and oral contraceptive therapy, followed by currently recommended approaches to the primary hyperlipidemias, which affect at least 1:500 persons. Guidelines for screening adolescents at risk and incremental treatment with diet and lipid-lowering medications, including statins, are reviewed in the context of current national recommendations.