SCREENING, DIAGNOSIS, AND THERAPY OF DYSLIPOPROTEINEMIA IN CHILDREN

Programs to control dyslipoproteinemia (DLP) in childhood have been co ntroversial because of the need for prolonged treatment during phases of rapid psychological and somatic development. The clinical challenge is to detect and provide intense, safe, and effective interventions f or a small group of children with DLP. This program should complement changes in lifestyle for the entire population of children over the ag e of 2 years that limits dietary total fat, saturated fatty acids and cholesterol, although increasing physical activity and preventing smok ing. The National Cholesterol Education Program has recommended select ive screening with serum total cholesterol in children with parental h istory of total cholesterol greater than or equal to 240 mg/dL or with serum lipoproteins in children with parental or grandparental history of premature (less than or equal to 55 years of age) cardiovascular d isease (CVD), Incomplete family history information and the young age of many parents diminishes the sensitivity and feasibility of this app roach. We recommend universal screening by measuring total cholesterol in all children and lipoproteins in those children with a history of parental premature CVD. This approach should increase the salience of CVD prevention to the children, parents, child health providers, and s chool authorities. Decreasing dietary fat, saturated fatty acids and c holesterol for these DLP children is safe, effective, and well tolerat ed. Bile acid binding resins are reserved for older, high cardiovascul ar risk children with low-density lipoproteins greater than or equal t o 160 mg/dL after diet therapy. Treatment of childhood DLP has signifi cant potential to decrease later risk of CVD by delaying the initiatio n and rate of progression of atherosclerosis.