Abstract

Childhood dyslipidaemia is one of the main traditional cardiovascular risk factors that initiate and exacerbate the atherosclerotic process. Healthcare providers may play a key role in the management of children with lipid abnormalities; however, they have to properly evaluate the normal lipid values and know the available treatment options in children and adolescents. Current guidelines recommend healthy behaviours as the first-line treatment for childhood dyslipidaemia. The therapeutic lifestyle changes should focus on dietary modifications, daily physical activity, reduction in body weight and tobacco smoking cessation. Parents play a key role in promoting their children’s healthy habits. In children with more severe forms of lipid abnormalities and in those who do not benefit from healthy behaviours, pharmacological therapy should be considered. Safe and effective medications are already available for children and adolescents. Statins represent the first-line pharmacological option, while ezetimibe and bile acid sequestrants are usually used as second-line drugs. Despite their limited use in children, other lipid-lowering agents (already approved for adults) are currently available or under study for certain categories of paediatric patients (e.g., familial hypercholesterolemia). Further studies are needed to evaluate the long-term efficacy, safety and tolerability of novel lipid-lowering drugs, especially in children.

Highlights

  • Childhood dyslipidaemia is one of the main traditional cardiovascular risk factors that initiate and exacerbate the atherosclerotic process

  • An altered lipid profile over time plays a key role in the initiation and progression of atherosclerotic process in children and adolescents

  • “paediatric problem” that correlates with future cardiovascular health, it seems necessary to recognise it early and promptly treat children with modifiable cardiovascular risk factors, such as dyslipidaemia

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Summary

Pathophysiology

Dyslipidaemia is a clinical condition that is characterised by disorders of lipid metabolism. Depending on the underlying cause, childhood dyslipidaemia may be classified into primary and secondary dyslipidaemia [3]. Primary dyslipidaemia is usually caused by inherited disorders in lipid metabolism: single or multiple gene mutations (e.g., gene mutations in low-density lipoprotein receptors) may alter both lipid production and removal. Among the forms of primary dyslipidaemia, familial combined hyperlipidaemia and familial hypercholesterolemia are the most common genetic causes of dyslipidaemia. Secondary dyslipidaemia typically occurs as the result of specific conditions, diseases or drugs that may interfere with lipid concentrations over time. Secondary causes of dyslipidaemia should always be evaluated and treated; the correct management of the causative disease may often result in lipid abnormalities resolution [10]

Paediatric Guidelines
Non-Pharmacological Approaches
Family-Based Approach
Pharmacological Treatment
Approved Pharmacological Treatment for Children
Non-Approved Pharmacological Treatment for Children
Additional Lipid-Lowering Options
Findings
Conclusions
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