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Identify familial hyperlipidemias (FH) associated with early cardiovascular disease, which are present in 1 in 300-500 children, but are asymptomatic until there is myocardial ischemia. Individuals with FH who are untreated have a risk of premature coronary heart disease 20 times greater than those without FH. (Of note, one study suggests the risk of cardiac events in FH can be reduced to that of the general adult population by statin therapy, but only if these lipid disorders are identified early.)
Diagnose non-genetic LDL lipid disorders that require lifestyle modification. NHANES data suggest 1 in 5 adolescents in the US has some type of lipid disorder (JAMA 2010, MMWR Morb Mortal Wkly Rep. 2010 Jan 22:59(2):29-33. Prevalence of abnormal lipid levels among youths. United States, 1999-2006. Centers for Disease Control and Prevention [CDC)].)
Screen all children once between the ages 9 and 11 years, and again once between 17 and 21 years.
Continue selective screening of high risk patients (family history of early CVD events or other CVD risk factors) starting at age 2 years.
Screen with a fasting lipid profile OR non-fasting TC and HDL to calculate non-HDL cholesterol levels.
If non-fasting non-HDL cholesterol is ≥ 145 mg/dL, or HDL < 40 mg/dL, obtain fasting lipid profile.
Refer to specialist directly for LDL ≥ 250 mg/dL or fasting TG≥ 500 mg/dL.
Initial treatment for nearly all patients is 6 months of targeted lifestyle change.
Treat high TG differently from high LDL, both in terms of nutrition counseling and pharmacotherapy (guidelines include useful tables and algorithms to guide treatment).
Use lipid-lowering medications only in patients who have not responded to 6 months of lifestyle counseling and have LDL ≥190 mg/dL.
Use somewhat lower LDL cutpoints for patients with high-risk conditions using lower cutpoints.
Recommended age for pharmacotherapy is ≥ 10 years, except in very high risk cases.
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