Lipid disorders in children and adolescents

A body of evidence now shows that elevated levels of plasma cholesterol, especially low-density lipoprotein cholesterol (LDL-C), are associated with an increased probability of premature cardiovascular disease in the adult. This is particularly true for subjects with the common familial hypercholesterolemia (FH) (a dominant disorder of lipoprotein metabolism), who typically manifest atherosclerosis in the fourth to fifth decade. There is also no doubt that the atherosclerotic process begins in childhood and therefore preventive measures should be initiated as early as possible to prevent progression of the disease (1). In 1992, the National Cholesterol Education Program (NCEP) Expert Panel on Blood Cholesterol in Children and Adolescents recommended that selective screening for the diagnosis of hypercholesterolemia should be implemented and that diagnosed children should be treated based on their LDL-C levels and identified risk factors (2). The magnitude of the obesity epidemic, the increasing prevalence of Type II diabetes in children, and recognition of the importance of other risk factors such as sedentary lifestyle, high blood pressure, and smoking are reflected in the recent publications of the American Heart Association (AHA) and the American Academy of Pediatrics, which provides guidelines for primary prevention of atherosclerosis in childhood (3,4).