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A rational approach to treating hypercholesterolaemia in children. Weighing the risks and benefits
1Ullevål Hospital, Oslo, Norway. serena.tonstad@rh.uio.no
Insights
Expert guidelines suggest reducing cardiovascular disease risk in children through population measures and treating high cholesterol. While low-fat diets are debated, bile acid-binding resins are the only approved drug for children, though compliance is a challenge.
Area of Science:
- Pediatrics
- Cardiovascular Health
- Nutritional Science
Background:
- Atherosclerosis is a lifelong process, necessitating early intervention strategies.
- Expert panels recommend guidelines for cardiovascular disease risk reduction starting in childhood.
- Current guidelines emphasize population-based measures and individual hypercholesterolemia treatment in children.
Purpose of the Study:
- To review current strategies for managing hypercholesterolemia in children.
- To evaluate the efficacy and safety of dietary and pharmacological interventions for pediatric lipid modification.
- To provide guidance on drug treatment for children at high risk of cardiovascular disease.
Main Methods:
- Review of existing literature on dietary interventions (low-fat diets, fiber, plant sterols, fish oils) for children.
- Analysis of clinical trial data for approved and investigational lipid-lowering drugs in pediatric populations.
- Assessment of safety, tolerability, and compliance issues associated with pharmacological treatments.
Main Results:
- Limited evidence supports significant growth stunting or nutritional deficiencies from appropriately substituted low-fat diets in children.
- Dietary adjuncts like fiber, plant sterols, and fish oils show limited efficacy in modifying pediatric lipid levels.
- Bile acid-binding resins are the sole approved drugs for lowering cholesterol in children, generally well-tolerated but face compliance challenges due to palatability.
- Data for HMG CoA reductase inhibitors and fibrates are insufficient for current pediatric recommendation.
- Drug therapy is reserved for children with exceptionally high risk, typically due to genetic dyslipidemias.
Conclusions:
- Management of hypercholesterolemia in children requires a balanced approach considering diet and medication.
- Bile acid-binding resins represent a viable, though imperfect, pharmacological option for pediatric cholesterol management.
- Further research is needed for other drug classes, with current drug treatment strictly limited to high-risk pediatric cases.
Abstract:
Because atherosclerosis is a continuous process throughout life, expert panels have suggested guidelines to reduce the risk of cardiovascular disease, starting from childhood. The guidelines focus on population-based measures and on treating hypercholesterolaemia in individual children. Low-fat diets in children have been widely debated. There is little evidence that growth is stunted or that nutritional deficiencies arise if the energy that is lost by limiting fat intake is substituted with other nutrients. Dietary fibre, plant sterols and fish oils have been used to modify lipid levels in children; however, the efficacy of these dietary adjuncts is limited. Bile acid-binding resins are the only approved drugs to lower cholesterol levels in children and appear to be well tolerated. However, compliance with resins is low because of unpalatability, so low dosages are preferred and vitamin supplementation is prudent. Data on HMG CoA reductase inhibitors and fibrates are insufficient to recommend these drugs at present. Drug treatment should be restricted to children who are at exceptionally high risk of disease, usually those with genetic dyslipidaemias.