Management of hyperlipidemia in the pediatric population

Abstract

Heterozygous familial hypercholesterolemia (FH) affects one in every 500 persons and is the most common cause of markedly elevated cholesterol levels in children. Other causes of primary hyperlipidemia include familial combined hyperlipidemia, which is also common (approximately 1%) but not usually manifest until after puberty, and very rare genetic disorders that may lead to severe hypertriglyceridemia and chylomicronemia syndrome. In children with heterozygous FH, the short-term risk of clinical events is low; therefore, management starts with stratification of risk, followed by dietary modification, and in high-risk cases, pharmacologic treatment initiated after puberty. Male gender, a family history of premature coronary heart disease, and level of low-density lipoprotein (LDL) cholesterol above 4.9 mmol/L are important determinants of risk. Trials have shown that statins effectively lower LDL cholesterol levels; in one study, statins restored endothelial function, with no clinically adverse effects. The effects of statins for longer than 2 years have not been studied. The use of bile acid sequestrants (resins) is limited by compliance and side effects. Children with homozygous FH require expert management with LDL apheresis, high doses of effective statins, and cardiologic follow-up. Ezetimibe, the first in a new class of cholesterol absorption inhibitors, may provide additional efficacy in homozygous FH.

Aorta and coronary angiographic follow‐up of children with severe hypercholesterolemia treated with low‐density lipoprotein apheresis

“…Therapeutic conduct, aggressive and intensive, constant and continuous, has made it possible for the children of this study who presented a compromising coronary atherosclerosis in 45.4% of cases, to have an interruption in the evolution of the atherosclerotic process and, in some cases, regression of existing arteriosclerotic lesions. As amply described in literature by Thompson and colleagues, and also in our patients, atherosclerotic involvement of the aortic valve was not substantially modified if treatment with LDLa was not begun at an early age, preferably around 6 years of age or earlier 3,32‐36 . In 54.5% of patients (7 of 11) involvement of the aortic valve was existing at the beginning of LDLa.…”

A Systematic Review and Meta-Analysis of Statin Therapy in Children With Familial Hypercholesterolemia

“…Until recently, only dietary interventions and bile acid binding resins were recommended but efficacy and compliance were mostly poor. 11,12 Based on the efficacy and safety in adults, statins were expected to be beneficial for children as well. Hence, a number of clinical studies were performed to evaluate statin therapy in children with HeFH.…”

Familial hypertriglyceridemia

“…1,2 Omega-3 fatty acids (fish oils) that lower VLDL production may be tried in severe hypertriglyceridemia, but the data on their use in children is inadequate. 1,2,4 Drug therapy with fibrates and nicotinic acid (to lower VLDL level and increase HDL level) or oxandrolone is rarely indicated. 1,2,4 This case is being reported for its rarity and unusual presentation.…”

“…1,2,4 Drug therapy with fibrates and nicotinic acid (to lower VLDL level and increase HDL level) or oxandrolone is rarely indicated. 1,2,4 This case is being reported for its rarity and unusual presentation.…”