Hyperlipidemia NCEP recommendations for drug therapy of high-risk hyperlipidemia in children and adolescents

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

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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 (DO NOT EDIT)

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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 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 >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

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

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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: Male gender Strong family history of premature cardiovascular disease or events 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 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 hypertension Current smoking and passive smoke exposure Presence of novel and emerging risk factors and markers, e.g., elevated lipoprotein(a), homocysteine, C-reactive protein 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.

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