Medication Induced Dyslipidemia in Children

The prevalence of dyslipidemia in the pediatric population continues to rise, increasing the future risk of atherosclerotic cardiovascular disease (ASCVD) as these children transition to adulthood. Timely diagnosis and intervention, beginning at a young age, is important in reducing the risk of ASCVD and preventing premature mortality in this vulnerable population. Implementation of a heart-healthy lifestyle should be encouraged in all children, and, when appropriate, the role of medication discussed in those at-risk. The purpose of this review is to discuss the impact of non-lipid lowering medications which affect lipid and lipoprotein metabolism in children (< 18 years-of-age).

According to National Center of Health Statistics, there has been a steady rise of pediatric obesity and cardiovascular disease (CVD) risk amongst youth over the last 2 decades, with roughly 1 out of 5 children having a BMI > 95th percentile for their age and gender. Such a rise can contribute to an increase of CVD risk factors, which play a role in the development of atherosclerosis. Evidence of atherosclerosis appears as early as childhood, progresses throughout adolescences, and accelerates after 20 years-of-age. Although some children are genetically predisposed to dyslipidemia, many have elevated lipids and lipoproteins as a result of unhealthy lifestyles - high fat, high carbohydrate diets, lack of exercise, and use of medications for other health conditions. In a 2023 survey, it was predicted that approximately 40.1% of children < 17 years-of-age have had at least one medication prescribed for a short or long-term health condition within the past 12 months. Clinicians should be aware of health conditions and medications that can adversely affect lipid levels when evaluating and treating children with lipid disorders. With the increased prevalence of lipid disorders in the pediatric population, healthcare providers are searching for both primary and secondary causes including the influence of certain medications or drug classes known to cause lipid abnormalities in adults, identifying similar findings amongst children. These include but are not limited to corticosteroids, retinoid agents, beta blockers, oral contraceptives, chemotherapy agents, antiretroviral medications, androgenic steroids and behavioral medications.