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Review
. 2021 Apr 14;11(4):345.
doi: 10.3390/life11040345.

Early Prevention of Atherosclerosis: Detection and Management of Hypercholesterolaemia in Children and Adolescents

Cristina Pederiva  1 , Maria Elena Capra  2 , Claudia Viggiano  1 , Valentina Rovelli  1 , Giuseppe Banderali  1 , Giacomo Biasucci  2
Affiliations
Review

Early Prevention of Atherosclerosis: Detection and Management of Hypercholesterolaemia in Children and Adolescents

Cristina Pederiva et al. Life (Basel). .

Abstract

Coronary heart disease (CHD) is the main cause of death and morbidity in the world. There is a strong evidence that the atherosclerotic process begins in childhood and that hypercholesterolaemia is a CHD major risk factor. Hypercholesterolaemia is a modifiable CHD risk factor and there is a tracking of hypercholesterolaemia from birth to adulthood. Familial hypercholesterolaemia (FH) is the most common primitive cause of hypercholesterolaemia, affecting 1:200-250 individuals. Early detection and treatment of hypercholesterolaemia in childhood can literally "save decades of life", as stated in the European Atherosclerosis Society Consensus. Multiple screening strategies have been proposed. In 2008, the American Academy of Pediatrics published the criteria for targeted screening, while some expert panels recommend universal screening particularly in the young, although cost effectiveness has not been fully analysed. Blood lipid profile evaluation [total cholesterol, Low-Density Lipoprotein Cholesterol (LDL-C), High-Density Lipoprotein Cholesterol (HDL-C) and triglycerides] is the first step. It has to be ideally performed between two and ten years of age. Hypercholesterolaemia has to be confirmed with a second sample and followed by the detection of family history for premature (before 55 years in men and 60 years in women) or subsequent cardio-vascular events and/or hypercholesterolaemia in 1st and 2nd degree relatives. The management of hypercholesterolaemia in childhood primarily involves healthy lifestyle and a prudent low-fat diet, emphasising the benefits of the Mediterranean diet. Statins are the cornerstone of the drug therapy approved in USA and in Europe for use in children. Ezetimibe or bile acid sequestrants may be required to attain LDL-C goal in some patients. Early identification of children with severe hypercholesterolaemia or with FH is important to prevent atherosclerosis at the earliest stage of development, when maximum benefit can still be obtained via lifestyle adaptations and therapy. The purpose of our review is to highlight the importance of prevention and treatment of hypercholesterolaemia starting from the earliest stages of life.

Keywords: CHD prevention; adolescents; children; early detection; hypercholesterolaemia.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Cholesterol exposure per year and correlation to age onset of CHD, Modified from A. Wiegman [7].
Figure 2
Figure 2
Diagnosis of FH in childhood, modified from Wiegman et al. [7].
Figure 3
Figure 3
Management of hypercholesterolaemia in childhood (created by Pederiva C and Capra M.E.).
See this image and copyright information in PMC

References

    1. Townsend N., Nichols M., Scarborough P., Rayner M. Cardiovascular disease in Europe—Epidemiological update 2015. Eur. Heart J. 2015;36:2696–2705. doi: 10.1093/eurheartj/ehv428. - DOI - PubMed
    1. Napoli C., D’Armiento F.P., Mancini F.P., Postiglione A., Witztum J.L., Palumbo G., Palinski W. Fatty streak formation occurs in human fetal aortas and is greatly enhanced by maternal hypercholesterolemia. Intimal accumulation of low density lipoprotein and its oxidation precede monocyte recruitment into early atherosclerotic lesions. J. Clin. Investig. 1997;100:2680–2690. doi: 10.1172/JCI119813. - DOI - PMC - PubMed
    1. Napoli C., Glass C.K., Witztum J.L., Deutsch R., D’Armiento F.P., Palinski W. Influence of maternal hypercholesterolaemia during pregnancy on progression of early atherosclerotic lesions in childhood: Fate of Early Lesions in Children (FELIC) study. Lancet. 1999;354:1234–1241. doi: 10.1016/S0140-6736(99)02131-5. - DOI - PubMed
    1. Brown M.S., Kovanen P.T., Goldstein J.L., Eeckels R., Vandenberghe K., van den Berghe H., Fryns J.P., Cassiman J.J. prenatal diagnosis of homozygous familial FH in children and adolescents 2437 hypercholesterolqmia Expression of a Genetic Receptor Disease in utero. Lancet. 1978;311:526–529. doi: 10.1016/S0140-6736(78)90552-4. - DOI - PubMed
    1. Berenson G.S., Srinivasan S.R., Bao W., Newman W.P., Tracy R.E., Wattigney W.A. Association between multiple cardiovascular risk factors and the early development of atherosclerosis. Bogalusa Heart Study. N. Engl. J. Med. 1998;338:1650–1656. doi: 10.1056/NEJM199806043382302. - DOI - PubMed

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