Cardiovascular Risk Modification in Childhood: Hyperlipidemia

Abstract

The association between plasma cholesterol level and coronary artery disease in adults has been clearly determined in studies conducted by the Lipid Research Clinics and the National Heart, Lung, and Blood Institute.l" Whether plasma cholesterol level and other "risk factors" apply to children and adolescents is unknown; however, it is highly likely that atherosclerosis begins sometime in childhood or adolescence, and preventive measures instituted early in life may alter the development and progression of the disease. Risk factors that are alterable in childhood include plasma cholesterol level (low-density lipoprotein [LDL] cholesterol), smoking, sedentary lifestyle, obesity, and diabetes mellitus. The plasma cholesterol level is the most controversial issue. Methods for Reducing Cholesterol Levels in Children.-Children in countries with a high incidence of coronary artery disease have higher plasma cholesterol levels than other children. Of American children, 5% have cholesterol levels that exceed 200 to 220 mg/dl (mean concentration, 160 mg/dl). Currently, a goal has been established to reduce the mean plasma cholesterol level in children to 140 mg/dl." In an attempt to reach this goal, three strategies have been proposed: (1) measure lipid levels in all children and intervene only in those with elevated levels; (2) measure lipid levels in only those children from high-risk families; and (3) measure lipid levels in no children but recommend a low-cholesterol, low-saturated fat diet for all healthy children and adolescents. Universal screening may be inadvisable until an effective low-cost screening method has been developed. Identification and intervention in only those children from high-risk families would miss many children whose families are not in the medical system and those in whom the genetic influence is more subtle. Finally, recommendation of a univer