Israeli guidelines for the management of hypercholesterolemia in children and adolescents. Report of the pediatric association expert group

Background & aims: Elevated plasma LDL-C levels hold an essential role in the pathogenesis of the atherosclerotic process, which in fact initiates in childhood and early adolescence. The detection and intervention of hyperlipidemia among that age group may disrupt or prevent the progression of the atherosclerosis. Guidelines for the diagnosis and treatment of hypercholesterolemia among children and adolescents were published only in the United States. The current guidelines aim at providing a thorough assessment of the current concepts in the diagnosis, screening and therapeutic options for hypercholesterolemia in the pediatric age group. Methods and results: Literature review of Pubmed (1968-November 1, 2009) and the Cochrane Central Register of Controlled Trials served the authors in identifying relevant studies. Recommendations were made based on census of delegates representing adult and pediatric endocrinology and lipidology, pediatric gastroenterology, nutrition and epidemiology. The Israeli Pediatric Association endorsed these recommendations. Conclusions: The current recommendations endorse a healthy diet from infancy with limited fat intake. In the group of high-risk children with consistently elevated plasma LDL-C despite life style changes, drug therapy is recommended. Statins are the recommended first line of pharmacotherapy and there are a number of publications that ensure their short-term safety and efficacy among children and adolescents.