Dyslipidemia Diagnosis and Treatment: Risk Stratification in Children and Adolescents

Abstract

Dyslipidemias or dyslipoproteinemias are quantitative changes in total cholesterol concentration, respective fractions, or triglycerides in the plasma. Evidence supported that dyslipidemia in childhood is associated with atherosclerosis in adulthood, and early identification and treatment potentially reduce cardiovascular risk in adulthood, which is the principal cause of morbidity and mortality in developed countries. Dyslipidemias can result from primary lipoprotein metabolism changes due to different genetic causes (primary dyslipidemias) or as a consequence of exogenous factors or other pathologies (secondary dyslipidemias). Therefore, the combined dyslipidemias result from the association of important epigenetic and environmental influences with risk factors for cardiovascular disease. The criterion for lipid metabolism screening at young ages is not widely accepted and possibly follows a universal or directed screening strategy. Additionally, little is known about its long-term effects or possible risk-benefit despite the growing tendency to start pharmacological therapy. Therefore, this study aimed to review the available bibliography on dyslipidemia in pediatric age to present a practical and structured approach to dyslipidemia that focuses on screening, risk stratification for atherosclerotic disease, and therapeutic approach.

Figure 1

Dyslipidemia screening algorithm and secondary dyslipidemia causes. ¹Stroke with no identifiable cause, familial hypercholesterolemia, premature cardiovascular disease in 1^st or 2^nd degree relatives or 1^st degree relative with high levels of lipoprotein (a). HDL, High density lipoprotein; LDL, low density lipoprotein; Lp(a), Lipoproteina (a); TC, total cholesterol; TG, triglycerides; VLDL, very low density lipoprotein.

Figure 2

Dyslipidemia familial and individual risk factors. ^∗Familial history (1^st and 2^nd degrees) of premature cardiovascular disease (male <55 yr; female <65 yr)-angina or acute myocardial infarction, coronary artery bypass graft, angioplasty, stroke, peripheral artery disease, or sudden cardiac death; ^∗∗1^st degree relative: TC >240 mg/dl and/or LDL >130 mg/dl and/or TG >170 mg/dl and/or HDL <35 mg/dl.

Figure 3

Dyslipidemia therapeutic approach by risk stratification. (A) Lifestyle changes; (B) CHILD-1 Diet; (C) CHILD-2 Diet.