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[Anticholesteremic agents in children]
1Service de Gastro-Entérologie et de Nutrition Pédiatriques, Hôpital Armand-Trousseau, Paris, France. jean-philippe.girardet@trs.ap-hop-paris.fr
Insights
Cholesterol-lowering drugs are recommended for children with genetic high cholesterol conditions if diet fails. Bile acid-binding resins are the first choice, with statins an option for older children.
Area of Science:
- Pediatric Endocrinology
- Cardiovascular Disease Prevention
- Pharmacology
Context:
- Hypercholesterolemia in children is a key factor in preventing adult-onset coronary heart disease.
- Genetic dyslipidemias like familial hypercholesterolemia necessitate early intervention.
- High LDL-cholesterol levels in children with genetic conditions pose significant cardiovascular risks.
Purpose:
- To outline the appropriate use of cholesterol-lowering medications in pediatric patients.
- To define treatment thresholds for pharmacotherapy in children with inherited hypercholesterolemia.
- To review the safety and efficacy profiles of available drug classes for pediatric use.
Summary:
- Pharmacological treatment for hypercholesterolemia in children is indicated for hereditary conditions when LDL-cholesterol remains above 190 mg/dL after 6 months of diet.
- Bile acid-binding resins (colestyramine) are the primary choice due to established efficacy and safety in children.
- HMG-CoA reductase inhibitors (statins) may be used in children over 8-9 years old if adherence to resins is poor, though long-term safety is not fully known.
- Fibrates are effective but lack sufficient safety data from controlled pediatric studies.
Impact:
- Provides guidance for clinicians on managing pediatric hypercholesterolemia.
- Highlights the importance of early intervention for genetic lipid disorders.
- Informs treatment decisions regarding the selection and sequencing of lipid-lowering therapies in children.
Abstract:
The treatment of hypercholesterolaemia in children is often discussed as part of the primary prevention strategy for premature coronary disease in adults. Cholesterol-lowering drugs are appropriate in children with hereditary autosomal dominant diseases such as familial hypercholesterolaemia, familial Apo B100 deficiency, or combined familial dyslipidaemia. Indeed, these diseases are associated with a high risk of cardiovascular attacks in young adults. In children suffering from these diseases, cholesterol-lowering drugs are considered when the plasma low density-lipoprotein (LDL)-cholesterol concentration remains above 190 mg/dL after a 6-month dietary treatment. The drug of first choice remains bile acid-binding resines (colestyramine) because their efficacy and safety are well documented in children. HMG-CoA reductase inhibitors can be used in children older than 8 or 9 years of age in cases of an altered observance of colestyramine treatment, but their long-term tolerance is unknown. Fibrates are also efficient, however, their safety has not been evaluated in controlled studies through in children.