Stratification of risk in children with familial hypercholesterolemia with focus on psychosocial issues

This paper discusses the clinical implications of making a diagnosis of familial hypercholesterolemia (FH) in children and data on psychosocial issues.

The case for treating FH in children is based on pathophysiological considerations. Some authors claim that treatment may be harmful, partly because the psychosocial risks have not been assessed. The available data indicate that psychological distress does not seem to be a problem in testing and treating most children for FH, although a few may develop social and emotional problems, experience family conflicts, or have problems with the diet or bile acid binding resins.

Parental preferences and the psychosocial function of the child should be considered and a complete assessment should be made of the potential risk of coronary heart disease (CHD) on the basis of established CHD risk factors. Boys and girls with total cholesterol concentrations of > 7.0 mmol/L and a family history of early CHD (first or second degree relatives with CHD, in males before the age of 40 and in females before the age of 50 years), and boys with cholesterol concentrations of > 10.0 mmol/L regardless of family history, should be considered at high risk and start dietary treatment as early as possible (preferable before the age of ten years). Girls at high risk may start statins by the age of 18 years, whereas starting statins should be considered in boys between the ages of 10 and 18 years. Children with FH at low to moderate risk of CHD may wait until adulthood or start treatment depending on an individualized evaluation.