Treatment Of Dyslipidemia In Children Research Articles

Diagnosis and treatment of dyslipidemia in children and adolescents

Background: Atherosclerotic cardiovascular disease is a major cause of morbidity and mortality worldwide, including in South Korea. Dyslipidemia is an independent risk factor for the development of atherosclerotic cardiovascular diseases. There is strong evidence that atherosclerosis begins early in life and that elevated lipid levels in childhood predict elevated lipid levels into adulthood.Current Concepts: A universal approach for cholesterol screening in all children is recommended. Lipid profiles should be studied for all children aged 9 to 11 years and then for those aged 17 to 21 years, as cholesterol levels may vary after puberty. The non-fasting lipid profile can be as useful in detecting severe genetic dyslipidemias as the fasting lipid profile and thus can be used as a first-line screening in children. The initial treatment for dyslipidemia in a child always begins with a 6-month trial of lifestyle modifications, such as improvements in dietary and physical activity patterns. Statins are as effective in children as in adults and can lower low-density lipoprotein cholesterol levels by up to 50%. Therefore, they are considered first-line therapy for children who meet the criteria for pharmacological therapy.Discussion and Conclusion: Statins and non-statin lipid-lowering agents can lower cholesterol levels with minimal adverse effects in children and adolescents with hypercholesterolemia. However, limited data is currently available on the long-term safety and efficacy of lipid-lowering agents in the pediatric population. Furthermore, non-statin lipid-lowering agents are used far less frequently in children. Therefore, further long-term safety and efficacy studies on lipid-lowering agents in pediatric populations and clinical trials with non-statin lipid-lowering agents are required.

Phytosterol supplementation in the treatment of dyslipidemia in children and adolescents: a systematic review.

ABSTRACTObjective: To carry out a systematic review on the effects of phytosterol supplementation on the treatment of dyslipidemia in children and adolescents.Data sources: Review in the SciELO, Lilacs, Bireme, PubMed and Web of Science databases, with no time limit. Descriptors: phytosterols or plant sterols and dyslipidemias, hypercholesterolemia, cholesterol, children, adolescent, in English and Portuguese. The articles included were published in Portuguese, English or Spanish and evaluated the effect of phytosterol supplementation in pediatric patients with dyslipidemia. Documents that involved adults or animals, review papers, case studies and abstracts were excluded. Two authors performed independent extraction of articles. Of 113 abstracts, 19 were read in full and 12 were used in this manuscript.Data synthesis: Phytosterol supplementation to reduce cholesterol levels has been shown to be effective in reducing LDL-cholesterol levels by approximately 10%, with reductions above 10% in LDL-cholesterol levels observed after 8 to 12 weeks of intervention. Studies have not shown significant changes in HDL-cholesterol and triglyceride levels. Based on the absence of adverse effects, its use seems to be safe and of good tolerance in children and adolescents.Conclusions: Phytosterol supplementation seems to be of great therapeutic aid for the treatment of hypercholesterolemia in children and adolescents. Further studies assessing the long-term effect of phytosterol supplementation are necessary.

The epidemiological characteristics and related factors of dyslipidemia among children and adolescents aged 6-17 years from 7 provinces in China, 2012

Objective: To investigate the prevalence and related factors of dyslipidemia among children and adolescents aged 6-17 years in 7 provinces in China. Methods: Using the method of stratified cluster random sampling, 93 primary and secondary schools were selected from Guangdong, Hunan, Liaoning provinces, Shanghai, Chongqing, Tianjin municipalities and Ningxia Hui Autonomous Region in China, 2012. A total of 16 434 students aged 6-17 years old with completed physical and lipid profiles parameters were selected into this study from above 93 primary and secondary schools. Dyslipidemia was determined by the definition of Expert Advice on Prevention and Treatment of Dyslipidemia in Children and Adolescents in 2009. Logistic regression model was used to explore the factors related to dyslipidemia. Results: The prevalence of elevated total cholesterol, elevated triglyceride, elevated low-density lipoprotein cholesterol, low high-density lipoprotein cholesterol, and dyslipidemia was 5.4% (887 cases), 15.7% (2 578 cases), 3.0% (492 cases), 13.5% (2 221 cases) and 28.5% (4 679 cases) among children and adolescents aged 6-17 years, respectively. Sugary drinks intake ≥once per week (OR=1.14; 95%CI: 1.05-1.24), sedentary time >10 hours per day (OR=1.14, 95%CI: 1.01-1.28), overweight (OR=1.50, 95%CI: 1.33-1.70), and obesity (OR=2.62, 95%CI: 2.31-2.96) were significantly associated with the prevalence of dyslipidemia. Conclusion: The prevalence of dyslipidemia was high among children and adolescents aged 6-17 in 7 provinces in China, 2012. Sugary drinks intake ≥once per week, sedentary time >10 hours per day, overweight and obesity might be the risk factors of dyslipidemia among children and adolescents.

Update on screening, etiology, and treatment of dyslipidemia in children.

Cardiovascular disease is a leading cause of morbidity and mortality. Early identification and treatment of risk factors that accelerate this condition are paramount to preventing disease. To this effect, the National Heart Lung and Blood Institute (NHLBI), endorsed by the American Academy of Pediatrics, issued updated pediatric guidelines for cardiovascular risk reduction in 2011. Integration of these guidelines into pediatric practice may lessen cardiovascular morbidity. In addition to reviewing the NHLBI guidelines, a detailed literature search was performed on PubMed for clinical studies published between 2010 and 2013. Key search terms included "pediatric dyslipidemia/hyperlipidemia," "cardiovascular disease," "atherosclerosis," "familial hypercholesterolemia," "hypertriglyceridemia," and "diabetes." Additional citations from these publications were also reviewed. Final publications were selected for their relevance to the topic. These guidelines contain several important recommendations relative to lipid management, including screening all children with nonfasting non-high-density lipoprotein-cholesterol at ages 9-11 years, incorporation of aggressive lifestyle changes to meet cholesterol targets, and initiation of statin therapy for those with low-density lipoprotein-cholesterol elevation. In addition, both type 1 and type 2 diabetes are now considered high-risk conditions and have stringent cholesterol targets. The primary aim is early identification of children with familial hypercholesterolemia; however, these recommendations have met with some controversy. The purpose of this update is to summarize these recent lipid guidelines, present the relevant controversies, highlight common cholesterol disorders, and discuss dyslipidemia specific to the pediatric diabetes population. Identification and treatment of youth with dyslipidemia is of paramount importance to the reduction of future cardiovascular disease. Increasing the comprehension and application of the newest NHLBI guidelines is critical to improving cardiovascular outcomes.

Universal Screening and Drug Treatment of Dyslipidemia in Children and Adolescents

VER THE LAST FEW DECADES, THE THEORY THAT adultdiseasesbegininchildhoodhasbeenwidely discussed.Smoking,themostcommonunderlyingcauseofdeathforadultsintheUnitedStates, beginsbeforetheageof18yearsinthemajorityofadultsmokers. Obesity has become the largest health problem in the United States, and the difficulty of long-term weight loss for obesechildrenandadolescentsmeansthatmanyofthemwill beoverweightasadults.Therationaleforconsideringcardiovascular disease prevention efforts in childhood is compelling. Not only do risk factors track from childhood into adult life, but the development and progression of atherosclerosis, whichoftenstartsinchildhood,arealsodirectlyrelatedtothe number of risk factors and their severity. The recent report of the National Heart, Lung, and Blood Institute(NHLBI)ExpertPanelonIntegratedGuidelinesfor CardiovascularHealthandRiskReductioninChildrenandAdolescents 1 reviewsallthemajorcardiovasculardiseaseriskfactors and makes recommendations about their management. There is good evidence for the recommendations on screening for tobacco use and hypertension during childhood and adolescencetopreventlatercardiovasculardisease.Themost controversialrecommendationislikelytobeuniversalscreeningforlipidlevelsinchildrenat9to11yearsofageandagain at17to21yearsofage.InthenewNHLBIguidelines,highlevelsoflipidsinchildrenarelinkedtorecommendationsabout bothbehavioralanddrugtherapies.Therobustevidencethat high levels of low-density lipoprotein (LDL) cholesterol are a cause of atherosclerosis and clinical events is not matched bysimilarlevelsofevidencethatlong-term,perhapslifelong, drug treatment in young children is effective and safe. In adults, the health benefits of statins are well demonstrated. In a meta-analysis of 10 primary prevention clinical trials, statin use was associated with a 30% reduction (95% CI, 19%-39%) in coronary events and a 12% reduction (95% CI, 4%-19%) in total mortality. 2 Recent trials, meta-analyses, andlipidtreatmentguidelinessupportnotonlymoreaggressivestatintherapyinhigh-riskindividualsbutalsotheexpan

Use of Statins for Dyslipidemia in the Pediatric Population

Childhood dyslipidemia is on the rise and increasingly being recognized as an important risk factor for adult cardiovascular disease. Due to a heightened awareness surrounding this problem, the American Academy of Pediatrics published a clinical report concerning prevention, screening, diagnosis, and treatment of dyslipidemia in children. Of concern among practitioners is when to initiate pharmacologic therapy and which medications are safe and appropriate in children. The report addresses this concern by suggesting that pharmacologic management begin only in pediatric patients with substantially elevated LDL levels. Since statins are the drugs of choice among adult patients with elevated LDL levels, it would be appropriate to evaluate their outcome in pediatric patients. To evaluate the efficacy and safety of statins for the treatment of pediatric dyslipidemia, a comprehensive search was performed of the MEDLINE database and International Pharmaceutical Abstracts as well as references from additional review articles. The manufacturer was contacted for data regarding a newly approved statin. Fourteen trials were identified, eight of which were randomized, controlled trials involving greater than 50 patients with primary or familial hypercholesterolemia. Overall, the studies showed that statins are effective at lowering LDL levels (reduction from baseline: 17% to 50%) and are fairly well tolerated, with headache, gastrointestinal distress, and myalgia being the most common adverse effects. Statins were found to be an efficacious option for the management of familial hypercholesterolemia of childhood. However, concerns regarding long term safety and efficacy have not been established, and data in patients with secondary lipid disorders is lacking.

Management of dyslipidemia in children

Dyslipidemia is an important etiologic factor in the development of cardiovascular disease (CVD), which is a leading cause of death worldwide As CVD begins in childhood, and as dyslipidemia is an important risk factor for CVD, screening and treatment of dyslipidemia in adolescents and children becomes an important health matter. This review deals with issues related to screening, diagnosis and treatment of dyslipidemia in children and adolescents.

Formulary Coverage for Lipid-Lowering Drugs Recommended for Children

A cross-sectional assessment to describe availability, coverage, and pediatric labeling status of lipid-lowering drugs offered by 1 private and 1 public insurance plan formularies. Both insurance plans had equal medication availability of bile acid sequestrants (7), statins (10), and cholesterol-absorption blockers (CAB; 1). The private plan had 3 bile acid sequestrants and 3 statins listed as preferred drugs; the CAB was not preferred. In contrast, the public plan had 5 bile acid sequestrants, 7 statins, and the CAB as preferred drugs. For medications with pediatric labeling, the private plan covered 50% as preferred drugs whereas the public plan covered 70% as preferred drugs. If new recommendations of the American Academy of Pediatrics for treatment of dyslipidemia in children were implemented today, children with the public plan would have equal choice but better coverage of lipid-lowering drugs as preferred drugs, including those with FDA approval, compared with children with the private plan.

Screening and Treatment for Lipid Disorders in Children and Adolescents: Systematic Evidence Review for the US Preventive Services Task Force

This was a systematic evidence review for the US Preventive Services Task Force, intended to synthesize the published evidence regarding the effectiveness of selecting, testing, and managing children and adolescents with dyslipidemia in the course of routine primary care. Literature searches were performed to identify published articles that addressed 10 key questions. The review focused on screening relevant to primary care of children without previously identified dyslipidemias, but included treatment trials of children with dyslipidemia because some drugs have only been tested in that population. Normal values for lipids for children and adolescents are defined according to population levels (percentiles). Age, gender, and racial differences and temporal trends may alter these statistical cut points. Approximately 40% to 55% of children with elevated total cholesterol and low-density lipoprotein levels will continue to have elevated lipid levels on follow-up. Current screening recommendations based on family history will fail to detect substantial numbers (30%-60%) of children with elevated lipid levels. Drug treatment for dyslipidemia in children has been studied and shown to be effective only for suspected or proven familial monogenic dyslipidemias. Intensive dietary counseling and follow-up can result in improvements in lipid levels, but these results have not been sustained after the cessation of the intervention. The few trials of exercise are of fair-to-poor quality and show little or no improvements in lipid levels for children without monogenic dyslipidemias. Although reported adverse effects were not serious, studies were generally small and not of sufficient duration to determine long-term effects of either short or extended use. Several key issues about screening and treatment of dyslipidemia in children and adolescents could not be addressed because of lack of studies, including effectiveness of screening on adult coronary heart disease or lipid outcomes, optimal ages and intervals for screening children, or effects of treatment of childhood lipid levels on adult coronary heart disease outcomes.

Summary of the American Heart Association’s Scientific Statement on Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents

Drug therapy of lipid abnormalities in children and adolescents has been surrounded with controversy. Much of the debate is about the evidence that intervening in asymptomatic youth will reduce disease morbidity or mortality in adulthood. There is also particular concern that the increasing prevalence of lipid abnormalities associated with the epidemic of pediatric obesity will lead to a generation of children taking long-term medication for lifestyle-related issues. The Writing Group, therefore, sought to examine the current state of evidence and guidelines and to provide clarifications and modifications, which are detailed in their Scientific Statement.1 See Circulation . 2007;115:1948–1967 A substantial body of evidence now exists to assert that the atherosclerotic process begins in childhood and is associated with the recognized cardiovascular risk factors. Pathologic studies, such as the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Study, have shown strong associations with the extent of early atherosclerotic lesions and levels of risk factors, including lipid abnormalities. An important observation from pathology studies has been the geometric association between increasing number of risk factors and the extent of lesions, which has important implications in view of the increasing prevalence of risk factor clustering associated with …

Treatment of dyslipidemia in children and adolescents

The early lesions of atherosclerosis begin in childhood, and are related to antecedent cardiovascular disease risk factors. Environmental and genetic factors such as diet, obesity, exercise, and certain inherited dyslipidemias influence the progression of such lesions. The identification of youth at risk for atherosclerosis includes an integrated assessment of these predisposing factors. Treatment starts with a diet low in total and saturated fat and cholesterol, the use of water-soluble fiber and plant sterols, weight control, and exercise. Drug therapy, for example, with inhibitors of hydroxymethylglutaryl CoA reductase, bile acid sequestrants, and cholesterol absorption inhibitors, can be considered in those with a positive family history of premature coronary artery disease and a low-density lipoprotein cholesterol above 160 mg/dL, after dietary and hygienic measures. Candidates for drug therapy often include those with familial hypercholesterolemia, familial combined hyperlipidemia, the metabolic syndrome, polycystic ovarian syndrome, type I diabetes, and the nephrotic syndrome. We review the safety and efficacy of dietary and drug therapy, and propose an updated diagnostic and therapeutic algorithm that includes the metabolic syndrome. The early identification and treatment of youth with dyslipidemias is likely to retard the atherosclerotic process.

Dyslipidemia in pediatric renal disease: epidemiology, pathophysiology, and management.

Dyslipidemia increases the risk of cardiovascular events among individuals with renal disease, and there is a growing body of evidence that it hastens the progression of renal disease itself. Children with nephrotic syndrome or renal transplants have easily recognized hyperlipidemia. Among those with chronic renal insufficiency or end-stage renal disease, detection of dyslipidemia requires more careful analysis and knowledge of normal pediatric ranges. Disordered lipoprotein metabolism results from complex interactions among many factors, including the primary disease process, use of medications such as corticosteroids, the presence of malnutrition or obesity, and diet. The systematic treatment of dyslipidemia in children with chronic renal disease is controversial because conclusive data regarding the risks and benefits are lacking. Hepatic 3-methylglutaryl coenzyme A reductase inhibitors (statins), fibrates, plant stanols, bile acid-binding resins, and dietary manipulation are options for individualized treatment. Prospective investigations are required to guide clinical management.