Clinical Management of Pediatric Dyslipidemia
Clinical Management of Pediatric Dyslipidemia
During the last 50 years, it has become evident that atherosclerosis originates in childhood. Although cardiovascular disease (CVD) events are rare in children, autopsy data and imaging studies have documented subclinical disease in association with measurable risk factors during childhood. When present at a young age, risk factors track into adulthood and have been associated with a moderate to high risk of future CVD. As such, the ability to identify this vulnerable population creates the opportunity to prevent the development of risk factors and future CVD events with effective management of genetic and acquired risk factors.
In 2011, the National Heart, Lung, and Blood Institute Expert Panel published comprehensive guidelines summarizing the current evidence and providing developmentally appropriate recommendations for screening, treatment, and follow-up of children and adults younger than 21 years at risk for premature CVDs such as myocardial infarction and stroke. In addition to screening individuals with a family history of hypercholesterolemia and/or premature CVD, the Expert Panel recommended universal screening of all children between 9 and 11 years of age and then again between 17 and 21 years of age. Although the recommendation for universal screening, regardless of general health or the presence/absence of risk factors of CVD, is not without controversy, this review serves to create awareness among healthcare providers, elected officials, and the lay public about the burden of CVD, the opportunity for prevention, and the benefits of early and effective therapeutic intervention with lifestyle changes and lipid-lowering medications.
During the last 50 years, it has become evident that atherosclerosis originates in childhood. A variety of techniques have been used to identify children and adolescents with early atherosclerotic vascular changes attributable to genetic and/or acquired cardiovascular disease (CVD) risk factors. Although CVD events are rare in children, autopsy data and imaging studies (eg, coronary intima-media thickness, brachial artery distensibility, and carotid artery calcium scores) have documented subclinical disease in children. When present at a young age, CVD risk factors progress into adulthood and have been associated with a moderate to high risk of future CVD. The ability to identify this vulnerable population creates the opportunity to prevent the development of risk factors and future CVD events with effective management of genetic and acquired risk factors.
In 1992, the National Cholesterol Education Program published the first guidelines for lipid screening in children and adolescents, advocating two key strategies: a population-based approach to encourage heart-healthy living for all children and targeted lipid screening using the family history to identify children likely to have familial hypercholesterolemia (FH) or familial combined hyperlipidemia (FCH). With additional knowledge and experience, these guidelines have been revised to include other risk factors and associated conditions that further accelerate the risk for future CVD (Fig. 1).
(Enlarge Image)
Figure 1.
Evolution of pediatric guidelines for dyslipidemia.
In 2011, the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel published updated guidelines for cardiovascular health and risk reduction in youth. This comprehensive report summarizes current evidence and provides developmentally appropriate recommendations for screening, treatment, and follow-up of children and adults younger than 21 years at risk for premature CVD, such as myocardial infarction and stroke. Publication of the NHLBI guidelines has fostered a healthy debate, both pro and con, on how best to prevent CVD starting in youth.
Abstract and Introduction
Abstract
During the last 50 years, it has become evident that atherosclerosis originates in childhood. Although cardiovascular disease (CVD) events are rare in children, autopsy data and imaging studies have documented subclinical disease in association with measurable risk factors during childhood. When present at a young age, risk factors track into adulthood and have been associated with a moderate to high risk of future CVD. As such, the ability to identify this vulnerable population creates the opportunity to prevent the development of risk factors and future CVD events with effective management of genetic and acquired risk factors.
In 2011, the National Heart, Lung, and Blood Institute Expert Panel published comprehensive guidelines summarizing the current evidence and providing developmentally appropriate recommendations for screening, treatment, and follow-up of children and adults younger than 21 years at risk for premature CVDs such as myocardial infarction and stroke. In addition to screening individuals with a family history of hypercholesterolemia and/or premature CVD, the Expert Panel recommended universal screening of all children between 9 and 11 years of age and then again between 17 and 21 years of age. Although the recommendation for universal screening, regardless of general health or the presence/absence of risk factors of CVD, is not without controversy, this review serves to create awareness among healthcare providers, elected officials, and the lay public about the burden of CVD, the opportunity for prevention, and the benefits of early and effective therapeutic intervention with lifestyle changes and lipid-lowering medications.
Introduction
During the last 50 years, it has become evident that atherosclerosis originates in childhood. A variety of techniques have been used to identify children and adolescents with early atherosclerotic vascular changes attributable to genetic and/or acquired cardiovascular disease (CVD) risk factors. Although CVD events are rare in children, autopsy data and imaging studies (eg, coronary intima-media thickness, brachial artery distensibility, and carotid artery calcium scores) have documented subclinical disease in children. When present at a young age, CVD risk factors progress into adulthood and have been associated with a moderate to high risk of future CVD. The ability to identify this vulnerable population creates the opportunity to prevent the development of risk factors and future CVD events with effective management of genetic and acquired risk factors.
In 1992, the National Cholesterol Education Program published the first guidelines for lipid screening in children and adolescents, advocating two key strategies: a population-based approach to encourage heart-healthy living for all children and targeted lipid screening using the family history to identify children likely to have familial hypercholesterolemia (FH) or familial combined hyperlipidemia (FCH). With additional knowledge and experience, these guidelines have been revised to include other risk factors and associated conditions that further accelerate the risk for future CVD (Fig. 1).
(Enlarge Image)
Figure 1.
Evolution of pediatric guidelines for dyslipidemia.
In 2011, the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel published updated guidelines for cardiovascular health and risk reduction in youth. This comprehensive report summarizes current evidence and provides developmentally appropriate recommendations for screening, treatment, and follow-up of children and adults younger than 21 years at risk for premature CVD, such as myocardial infarction and stroke. Publication of the NHLBI guidelines has fostered a healthy debate, both pro and con, on how best to prevent CVD starting in youth.
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