Hyperlipidemia NCEP recommendations for drug therapy of high-risk hyperlipidemia in children and adolescents: Difference between revisions

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* Consider drug therapy in '''children ≥10 years of age''' (usually wait until [[menarche]] for females) and after a '''6- to 12-month trial of fat- and cholesterol-restricted dietary management'''.
* Consider drug therapy in children ≥10 years of age (usually wait until [[menarche]] for females) and after a 6- to 12-month trial of fat- and cholesterol-restricted dietary management.
* Consider drug therapy if
* Consider drug therapy if
** [[LDL]] level remains '''≥4.90 mmol/L (190 mg/dL)''' or
** [[LDL]] level remains ≥4.90 mmol/L (190 mg/dL) or
** [[LDL]] remains '''>4.10 mmol/L (160 mg/dL)''' and there is a positive family history of '''premature cardiovascular disease''' or ≥2 other risk factors are present in the child or adolescent after vigorous attempts to control these risk factors.
** [[LDL]] remains >4.10 mmol/L (160 mg/dL) and there is a positive family history of premature cardiovascular disease or ≥2 other risk factors are present in the child or adolescent after vigorous attempts to control these risk factors.
* Referral to specialized lipid center may be deemed appropriate.
* Referral to specialized lipid center may be deemed appropriate.
* '''Treatment goal'''
* Treatment goal
** Minimal, LDL '''<3.35 mmol/L (130 mg/dL)'''
** Minimal, LDL <3.35 mmol/L (130 mg/dL)
** Ideal, LDL '''<2.85 mmol/L (110 mg/dL)'''
** Ideal, LDL <2.85 mmol/L (110 mg/dL)
}}
}}


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* In addition to family history, overweight and [[obesity]] should trigger screening with a fasting [[lipid profile]].
* In addition to family history, overweight and [[obesity]] should trigger screening with a fasting [[lipid profile]].
* [[Overweight]] and obese children with lipid abnormalities should be screened for other aspects of the [[metabolic syndrome]] (i.e., [[insulin resistance]] and [[type 2 diabetes]], [[hypertension]], or [[central adiposity]]).
* [[Overweight]] and obese children with lipid abnormalities should be screened for other aspects of the [[metabolic syndrome]] (i.e., [[insulin resistance]] and [[type 2 diabetes]], [[hypertension]], or [[central adiposity]]).
* '''For children meeting criteria for starting lipid-lowering drug therapy, a [[statin]] is recommended as first-line treatment'''.
* For children meeting criteria for starting lipid-lowering drug therapy, a [[statin]] is recommended as first-line treatment.
* For children with high-risk lipid abnormalities, the presence of additional risk factors or high-risk conditions may also lower the recommended cutpoint LDL cholesterol level for initiation of drug therapy, lower the desired target LDL cholesterol levels, and in selected cases, may prompt consideration for '''initiation below the age of 10 years'''. These risk factors and high-risk conditions may include:
* For children with high-risk lipid abnormalities, the presence of additional risk factors or high-risk conditions may also lower the recommended cutpoint LDL cholesterol level for initiation of drug therapy, lower the desired target LDL cholesterol levels, and in selected cases, may prompt consideration for initiation below the age of 10 years. These risk factors and high-risk conditions may include:
** Male gender
** Male gender
** Strong family history of [[premature cardiovascular disease]] or events
** Strong family history of [[premature cardiovascular disease]] or events
** Presence of associated '''low [[high-density lipoprotein]] ([[HDL]]), high [[triglycerides]], small dense [[LDL]]'''
** Presence of associated low [[high-density lipoprotein]] ([[HDL]]), high [[triglycerides]], small dense [[LDL]]
** Presence of overweight or obesity and aspects of the metabolic syndrome
** Presence of overweight or obesity and aspects of the metabolic syndrome
** Presence of other medical conditions associated with an increased atherosclerotic risk such as [[diabetes]], [[human immunodeficiency virus]] (HIV) infection, [[systemic lupus erythematosus]], organ [[transplantation]], survivors of childhood [[cancer]]
** Presence of other medical conditions associated with an increased atherosclerotic risk such as [[diabetes]], [[human immunodeficiency virus]] (HIV) infection, [[systemic lupus erythematosus]], organ [[transplantation]], survivors of childhood [[cancer]]

Revision as of 18:55, 19 February 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Lipoprotein Disorders Microchapters

Patient Information

Overview

Causes

Classification

Hyperlipoproteinemia
Hypolipoproteinemia

Treatment

Overview

Children and adolescents with high-risk hyperlipidemia require lipid-lowering drug therapy, particularly those with familial hypercholesterolemia, despite compliance with lifestyle recommendations.

NCEP Recommendations for Drug Therapy of High-Risk Hyperlipidemia in Children and Adolescents

Original Recommendations of the National Cholesterol Education Program (NCEP) Expert Panel for Drug Therapy of High-Risk Hyperlipidemia in Children and Adolescents [1] (DO NOT EDIT)

“
  • Consider drug therapy in children ≥10 years of age (usually wait until menarche for females) and after a 6- to 12-month trial of fat- and cholesterol-restricted dietary management.
  • Consider drug therapy if
    • LDL level remains ≥4.90 mmol/L (190 mg/dL) or
    • LDL remains >4.10 mmol/L (160 mg/dL) and there is a positive family history of premature cardiovascular disease or ≥2 other risk factors are present in the child or adolescent after vigorous attempts to control these risk factors.
  • Referral to specialized lipid center may be deemed appropriate.
  • Treatment goal
    • Minimal, LDL <3.35 mmol/L (130 mg/dL)
    • Ideal, LDL <2.85 mmol/L (110 mg/dL)
 ”

Current Modifications of the National Cholesterol Education Program (NCEP) Expert Panel for Drug Therapy of High-Risk Hyperlipidemia in Children and Adolescents [1] (DO NOT EDIT)

“
  • In addition to family history, overweight and obesity should trigger screening with a fasting lipid profile.
  • Overweight and obese children with lipid abnormalities should be screened for other aspects of the metabolic syndrome (i.e., insulin resistance and type 2 diabetes, hypertension, or central adiposity).
  • For children meeting criteria for starting lipid-lowering drug therapy, a statin is recommended as first-line treatment.
  • For children with high-risk lipid abnormalities, the presence of additional risk factors or high-risk conditions may also lower the recommended cutpoint LDL cholesterol level for initiation of drug therapy, lower the desired target LDL cholesterol levels, and in selected cases, may prompt consideration for initiation below the age of 10 years. These risk factors and high-risk conditions may include:
  • Ongoing research of drug therapy of high-risk lipid abnormalities in children is needed, particularly with regard to long-term efficacy and safety, and impact on the atherosclerotic disease process.
 ”

References

  1. ↑ 1.0 1.1 McCrindle BW, Urbina EM, Dennison BA, Jacobson MS, Steinberger J, Rocchini AP; et al. (2007). "Drug therapy of high-risk lipid abnormalities in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, with the Council on Cardiovascular Nursing". Circulation. 115 (14): 1948–67. doi:10.1161/CIRCULATIONAHA.107.181946. PMID 17377073.

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