Ambika P Ashraf1, Bhuvana Sunil2, Vaneeta Bamba3, Emily Breidbart4, Preneet Cheema Brar5, Stephanie Chung6, Anshu Gupta7, Aditi Khokhar8, Seema Kumar9, Marissa Lightbourne10, Manmohan K Kamboj11, Ryan S Miller12, Nivedita Patni13, Vandana Raman14, Amy S Shah15, Don P Wilson16, Brenda Kohn17. 1. Division of Pediatric Endocrinology & Diabetes, University of Alabama at Birmingham, Birmingham, AL 35233, USA. 2. Department of Pediatrics, Division of Pediatric Endocrinology & Diabetes, University of Alabama at Birmingham, Birmingham, AL 35233, USA. 3. Department of Pediatrics, Division of Endocrinology, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA. 4. Department of Pediatrics, Division Pediatric Endocrinology and Diabetes NYU Grossman School of Medicine, New York, NY 10016, USA. 5. Department of Pediatrics, Division Pediatric Endocrinology and Diabetes, NYU Langone Medical Center, NYU Grossman School of Medicine, New York, NY 10016, USA. 6. Section on Pediatric Diabetes, Obesity, and Metabolism, National Institutes of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, MD 20814, USA. 7. Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA 23219, USA. 8. Department of Pediatrics, Rutgers New Jersey Medical School, NJ 07103, USA. 9. Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA. 10. Pediatric and Adult Endocrinology Faculty, NICHD, National Institutes of Health, Bethesda, MD 20814, USA. 11. Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH 43205, USA. 12. Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21093, USA. 13. Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX 75390, USA. 14. Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA. 15. Department of Pediatrics, Adolescent Type 2 Diabetes Program, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. 16. Cardiovascular Health and Risk Prevention, Pediatric Endocrinology and Diabetes, Cook Children's Medical Center, Fort Worth, TX 76104, USA. 17. Division Pediatric Endocrinology and DiabetesNYU Langone Medical Center, NYU Grossman School of Medicine, New York, NY 10016, USA.
Abstract
CONTEXT: Identification of modifiable risk factors, including genetic and acquired disorders of lipid and lipoprotein metabolism, is increasingly recognized as an opportunity to prevent premature cardiovascular disease (CVD) in at-risk youth. Pediatric endocrinologists are at the forefront of this emerging public health concern and can be instrumental in beginning early interventions to prevent premature CVD-related events during adulthood. AIM: In this article, we use informative case presentations to provide practical approaches to the management of pediatric dyslipidemia. CASES: We present 3 scenarios that are commonly encountered in clinical practice: isolated elevation of low-density lipoprotein cholesterol (LDL-C), combined dyslipidemia, and severe hypertriglyceridemia. Treatment with statin is indicated when the LDL-C is ≥190 mg/dL (4.9 mmol/L) in children ≥10 years of age. For LDL-C levels between 130 and 189 mg/dL (3.4-4.89 mmol/L) despite dietary and lifestyle changes, the presence of additional risk factors and comorbid conditions would favor statin therapy. In the case of combined dyslipidemia, the primary treatment target is LDL-C ≤130 mg/dL (3.4 mmol/L) and the secondary target non-high-density lipoprotein cholesterol <145 mg/dL (3.7 mmol/L). If the triglyceride is ≥400 mg/dL (4.5 mmol/L), prescription omega-3 fatty acids and fibrates are considered. In the case of triglyceride >1000 mg/dL (11.3 mmol/L), dietary fat restriction remains the cornerstone of therapy, even though the landscape of medications is changing. CONCLUSION: Gene variants, acquired conditions, or both are responsible for dyslipidemia during childhood. Extreme elevations of triglycerides can lead to pancreatitis. Early identification and management of dyslipidemia and cardiovascular risk factors is extremely important.
CONTEXT: Identification of modifiable risk factors, including genetic and acquired disorders of lipid and lipoprotein metabolism, is increasingly recognized as an opportunity to prevent premature cardiovascular disease (CVD) in at-risk youth. Pediatric endocrinologists are at the forefront of this emerging public health concern and can be instrumental in beginning early interventions to prevent premature CVD-related events during adulthood. AIM: In this article, we use informative case presentations to provide practical approaches to the management of pediatric dyslipidemia. CASES: We present 3 scenarios that are commonly encountered in clinical practice: isolated elevation of low-density lipoprotein cholesterol (LDL-C), combined dyslipidemia, and severe hypertriglyceridemia. Treatment with statin is indicated when the LDL-C is ≥190 mg/dL (4.9 mmol/L) in children ≥10 years of age. For LDL-C levels between 130 and 189 mg/dL (3.4-4.89 mmol/L) despite dietary and lifestyle changes, the presence of additional risk factors and comorbid conditions would favor statin therapy. In the case of combined dyslipidemia, the primary treatment target is LDL-C ≤130 mg/dL (3.4 mmol/L) and the secondary target non-high-density lipoprotein cholesterol <145 mg/dL (3.7 mmol/L). If the triglyceride is ≥400 mg/dL (4.5 mmol/L), prescription omega-3 fatty acids and fibrates are considered. In the case of triglyceride >1000 mg/dL (11.3 mmol/L), dietary fat restriction remains the cornerstone of therapy, even though the landscape of medications is changing. CONCLUSION: Gene variants, acquired conditions, or both are responsible for dyslipidemia during childhood. Extreme elevations of triglycerides can lead to pancreatitis. Early identification and management of dyslipidemia and cardiovascular risk factors is extremely important.
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