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Should pediatric patients with hyperlipidemia receive drug therapy?
1The Royal Oldham Hospital, Oldham, and Manchester Royal Infirmary, Manchester, United Kingdom. D.Bhatnagar@man.ac.uk
Insights
Hyperlipidemia in children is rising, mirroring adult coronary heart disease risks. Lipid-lowering drugs are generally recommended only for genetic disorders, with diet preferred for others.
Area of Science:
- Pediatric Cardiology
- Metabolic Disorders
- Public Health
Background:
- Hyperlipidemia is a significant risk factor for coronary heart disease (CHD) in adults.
- Increasing prevalence of childhood obesity, hyperlipidemia, and type 2 diabetes mellitus is observed globally.
- High serum lipid levels in children often persist into adulthood.
Purpose of the Study:
- To review the current understanding and recommendations for managing hyperlipidemia in children.
- To address the debate surrounding the appropriate use of lipid-lowering drugs in pediatric populations.
- To identify optimal screening and treatment strategies for pediatric hyperlipidemia.
Main Methods:
- Review of existing evidence on pediatric hyperlipidemia prevalence and risk factors.
- Analysis of screening methods, including genetic testing and biochemical markers.
- Evaluation of treatment options, including diet and pharmacotherapy.
Main Results:
- Obesity is identified as a key marker for screening high-risk children.
- Family history alone is insufficient for determining screening needs.
- Lipid-lowering drugs are generally advised only for children with genetic lipid metabolism disorders.
Conclusions:
- Dietary interventions are well-tolerated and effective for children.
- Long-term studies on the harm or benefit of lipid-lowering drugs in children are lacking.
- Lipid-lowering drug use in children should be restricted to specific genetic conditions, with other cases managed by diet and adult pharmacotherapy if necessary.
Abstract:
Hyperlipidemia is now established as a major risk factor for causation of coronary heart disease (CHD) in adults; however, there is much debate on the level of coronary risk at which lipid-lowering drugs should be used. These issues of possible harm or lack of benefit from long-term use of lipid-lowering therapy, and cost effectiveness, are also pertinent in the pediatric setting. Evidence from several countries indicates that children have an increasing prevalence of obesity, hyperlipidemia and type 2 diabetes mellitus. Children who have high serum lipids 'track' these increased levels into adulthood. In some countries there is a trend to screen children for hypercholesterolemia. Family history itself is a poor discriminator in determining which children need to be screened and treated. Estimation of apolipoprotein B and/or apolipoprotein E genotype can improve prediction. Measuring high density lipoprotein cholesterol also helps, but obesity appears to be the best marker for screening children at high risk. These considerations should not cloud the need for case finding and treatment of children with genetic disorders. Low fat diets have been shown to be well tolerated and effective in children; however, there are no major long-term studies demonstrating harm or benefit in those on lipid-lowering drugs. Nevertheless, concerns regarding the psychological effect and the theoretical metabolic effects of long-term lipid lowering remain. Lipid-lowering drugs should be generally restricted to children with genetic disorders of lipid metabolism. Children with diabetes mellitus, hypertension or nonlipid-related inherited disorders leading to premature CHD in adults should be treated with diet, and with lipid-lowering drugs when they reach adulthood. Children with secondary hyperlipidemia should be assessed individually. A number of drugs and nutriceuticals are available for use in children, but only a few drugs are licensed for use in children.