Management of hypercholesterolemia in children

Cardiovascular disease (CVD) remains the leading cause of death and morbidity in our society. One of the major risk factors for CVD is hypercholesterolemia. Hypercholesterolemia in children can be caused by a hereditary disorder or can be secondary to other diseases or drugs. In order to prevent CVD later in life, children with hypercholesterolemia should be identified and treated as early as possible. Currently, several different screening strategies have been developed, using either universal screening or case finding to search for children at risk. Once those children are identified, the first step in treatment is lifestyle adjustment. If cholesterol levels remain elevated, the drugs of first choice are statins. Other pharmacological options are ezetimibe or bile acid sequestrants. These agents have all proven to be safe and effective in lowering low-density lipoprotein cholesterol levels and improving surrogate markers of CVD. However, there is a need for long-term follow-up studies to answer the question as to whether it is safe to initiate treatment at a young age to prevent CVD later in life.