Screening for Lipid Disorders in Kids

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Screening for Lipid Disorders in Kids

Julie A. Brothers, MD


Posted: 07/05/2011

Hi, I'm Julie Brothers, Director of the Lipid Heart Clinic and a cardiologist of The Children's Hospital of Philadelphia [in Philadelphia, Pennsylvania]. The National Lipid Association (NLA) recently came out with guidelines for screening children for familial hypercholesterolemia (FH).[1] The familial hypercholesterolemias are a group of inherited genetic disorders that lead to both increased risk for high cholesterol as well as to early heart disease. The heterozygous form of FH occurs as much as in 1 in 300 to 1 in 500 individuals in the United States. With some populations, the ratio is as high as 1 in 100, such as in the French Canadians and the Dutch Afrikaners. FH is more prevalent than several other childhood diseases including cystic fibrosis, type 1 diabetes, and Down syndrome. It remains significantly underdiagnosed and undertreated. The new NLA guidelines recommend screening all children at ages 9-11 years old using a fasting lipid profile or a nonfasting, non-high-density lipoprotein (HDL) cholesterol. The non-HDL cholesterol is simply the total cholesterol minus HDL cholesterol.

The NLA continues to recommend, as does the American Heart Association and the American Academy of Pediatrics, that children as young as 2 years of age be screened with a fasting lipid profile if they are considered to be at higher risk for the development of early heart disease. These high-risk children include those with a family history of early heart disease as well as a family history of high cholesterol. It also includes children with congenital heart disease, diabetes, hypertension, overweight or obesity, and smoking or passive smoke exposure.

The diagnosis of FH should be suspected if the low-density lipoprotein (LDL) level is at or above 160 mg/dL or the non-HDL level is 190 mg/dL or greater. A repeat fasting lipid profile should be performed to assess for any response to dietary changes as well as to account for regression to the mean.

The primary care practitioner should be responsible for the screening and the diagnosis of FH. The treatment for FH should probably be done in conjunction with a lipid specialist or by referral to a lipid specialist. Treatment of FH always begins with diet and lifestyle management. This includes a low-saturated-fat diet, increasing physical activity, decreasing sedentary time, and attaining or maintaining a healthy weight. Treatment using medications should be considered if the LDL remains at or above 190 mg/dL despite several months of dietary and lifestyle changes. For some children, that LDL cutpoint will need to be lower if they are considered higher risk for early heart disease. Statins are the preferred medications for lipid lowering, and consideration for starting a statin should begin as low as 8 years of age. Clinical trials with medium-term follow-ups have shown that statins are both safe and efficacious in children.

In summary, screening children for FH is imperative for both early diagnosis and treatment to lower cholesterol and decrease the risk for early onset of atherosclerosis. At The Children's Hospital of Philadelphia's Lipid Heart Clinic, we are committed to managing and treating children with FH and other dyslipidemias that place them at risk for early heart disease. Thank you.

References

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