HYPERLIPIDEMIA IN CHILDREN AND ADOLESCENT S - DIAGNOSIS AND TREATMENT

Severe hyperlipidemias should be diagnosed and treated even in childho od and adolescence, because vascular lipid deposition in the form of f atty streaks and progressive atherosclerotic lesions start to develop early in life. The heterozygous form of familial hypercholesterolemia found in about 1 of 500 newborn infants, and polygenic forms of hyperc holesterolemia, are the most frequent forms of primary genetic hyperch olesterolemias found in children. Secondary hyperlipidemias, e.g. in d iabetes mellitus, hypothyroidism and renal disease, are relatively fre quent in children and adolescents and need to be searched for in the d iagnostic evaluation, because they can be influenced by treatment of t he underlying disorder. Children and adolescents with severe forms of hyperlipidemias should be diagnosed and treated early in life. Dietary modification is the basis of treatment of affected children and can l ower LDL cholesterol by about 15-20%. In patients with severe hypercho lesterolemia, dietary cholesterol intake should not exceed 150 mg/day in children or 250-300 mg/day in adolescents, Even more important is a reduction of the intake of saturated fats and trans fatty acids and t heir replacement by polyunsaturated and particularly monounsaturated f ats. Some additional lowering of LDL cholesterol may be achieved by th e preferential use of vegetable over animal proteins and of complex ca rbohydrates over sugars. Repeated motivation, counseling and intensive practical training of the patient and family, supported by appropriat e teaching materials, are essential for effective dietary treatment. A dditional drug treatment is considered in children from the age of 8-9 years of age onwards if, in spite of adequate dietary modification, L DL cholesterol remains above 190 mg/dl (4.9 mmol/l), or above 160 mg/d l (3.9 mmol/l) in the presence of additional risk factors. The drugs o f first choice are anion exchange resins (colestyramin or colestipol) because of their well documented efficacy and safety. More convenient to take but often somewhat less effective is beta-sitosterol. If effic acy or compliance with resins or sitosterin is unsatisfactory, fibrate s (e.g. bezafibrate, fenofibrate) may be considered as a drug of secon d choice. Cholesterol synthesis inhibitors are not recommended for gen eral use in children at this time.