Early Prevention of Atherosclerosis: Detection and Management of Hypercholesterolaemia in Children and Adolescents

Abstract

Coronary heart disease (CHD) is the main cause of death and morbidity in the world. There is a strong evidence that the atherosclerotic process begins in childhood and that hypercholesterolaemia is a CHD major risk factor. Hypercholesterolaemia is a modifiable CHD risk factor and there is a tracking of hypercholesterolaemia from birth to adulthood. Familial hypercholesterolaemia (FH) is the most common primitive cause of hypercholesterolaemia, affecting 1:200–250 individuals. Early detection and treatment of hypercholesterolaemia in childhood can literally “save decades of life”, as stated in the European Atherosclerosis Society Consensus. Multiple screening strategies have been proposed. In 2008, the American Academy of Pediatrics published the criteria for targeted screening, while some expert panels recommend universal screening particularly in the young, although cost effectiveness has not been fully analysed. Blood lipid profile evaluation [total cholesterol, Low-Density Lipoprotein Cholesterol (LDL-C), High-Density Lipoprotein Cholesterol (HDL-C) and triglycerides] is the first step. It has to be ideally performed between two and ten years of age. Hypercholesterolaemia has to be confirmed with a second sample and followed by the detection of family history for premature (before 55 years in men and 60 years in women) or subsequent cardio-vascular events and/or hypercholesterolaemia in 1st and 2nd degree relatives. The management of hypercholesterolaemia in childhood primarily involves healthy lifestyle and a prudent low-fat diet, emphasising the benefits of the Mediterranean diet. Statins are the cornerstone of the drug therapy approved in USA and in Europe for use in children. Ezetimibe or bile acid sequestrants may be required to attain LDL-C goal in some patients. Early identification of children with severe hypercholesterolaemia or with FH is important to prevent atherosclerosis at the earliest stage of development, when maximum benefit can still be obtained via lifestyle adaptations and therapy. The purpose of our review is to highlight the importance of prevention and treatment of hypercholesterolaemia starting from the earliest stages of life.

Nutraceuticals in Paediatric Patients with Dyslipidaemia

“…Nutraceuticals containing fibres and phytosterols should always be considered as a complement to the dietary [ 146 ] and lifestyle intervention, which remains the milestone approach in the treatment of dyslipidaemia in paediatric patients [ 147 ]. Nutraceuticals should be used for a short period and in those children who do not tolerate pharmacological therapy or who cannot yet receive it due to age limitations.…”

Endothelial Cell Plasma Membrane Biomechanics Mediates Effects of Pro-Inflammatory Factors on Endothelial Mechanosensors: Vicious Circle Formation in Atherogenic Inflammation

“…Connections between dyslipidemia and the mechanical properties of ECs were reviewed elsewhere [22]. Hypercholesterolemia leads to the accumulation of cholesterol in ECs, and promotes the development of inflammation and atherosclerosis [22,107,108]. An increase in low-density lipoprotein (LDL) cholesterol levels and a decrease in high-density lipoprotein (HDL) cholesterol levels in blood plasma are among the key risk factors for atherogenesis [107,109].…”

Nutritional Approach to Prevention and Treatment of Cardiovascular Disease in Childhood

“…A complete record of dietary habits must be obtained, and recommendations for a diet should be personalized and interpreted for each child to address individual diet patterns. The goal is to early establish correct habits that are most likely to be maintained over time, until adulthood [ 64 , 65 ]. The lipid intake, in particular cholesterol and saturated fats, is a major determinant of blood cholesterol levels.…”