Hypercholesterolemia in Youth: Opportunities and Obstacles to Prevent Premature Atherosclerotic Cardiovascular Disease

Abstract

Treatment of hypercholesterolemia in youth is predicated on the knowledge that we can identify those youth with this atherosclerotic risk factor most likely to develop premature cardiovascular disease. Unfortunately, this is not the case. Before we can adequately address appropriate lipid-lowering therapies in this special population, we must address and resolve current barriers related to screening and diagnosis. In this article, we describe some of the opportunities and obstacles that clinicians and policy makers confront when applying the current pediatric guidelines focused on screening and treating hypercholesterolemia in the pediatric population.

Dietary intake and blood lipid profile in overweight and obese schoolchildren

“…The prevention of cardiovascular diseases must begin decades prior to the onset of symptoms to be effective [4]. There are two types of prevention.…”

The Case for Treating Hypercholesterolemia at an Earlier Age

“…Here we confine our discussion to hypercholesterolemia. There is good reason to predict a very favorable risk/benefit ratio for early intervention, and there is a growing consensus that treatment-whether dietary or pharmacological-should start much sooner than is the practice today (17)(18)(19). There are understandable concerns about treating younger people and treating them for a lifetime.…”

Decreased prevalence of hypercholesterolaemia and stabilisation of obesity trends in 5-year-old children: possible effects of changed public health policies

“…It was previously reported that increased TC levels detect elevated LDL-C levels with 44-50% sensitivity and 90% specificity (34). In order to diagnose dyslipidaemia more than one blood value is needed (35). In Slovenian children with elevated TC levels O5 mmol/l a fasting lipid profile (TC, LDL, HDL and triglycerides) was carried out consequently.…”

“…The American Academy of Pediatrics recommends screening of children with a family history of premature CVD, a parental history of hypercholesterolaemia or when family history is unknown, and also screening of children with risk factors such as obesity, physical inactivity, hypertension, diabetes mellitus or smoking (35).…”