Abstract
This JCL Roundtable discussion probes the knowledge of 3 experts in pediatric lipidology,
an emerging discipline both in the United States and internationally. In the 1990s,
only 3 US institutions could be said to have dedicated pediatric lipid clinics; that
number has grown to 25 today. The Pediatric Atherosclerosis Prevention and Lipidology
Group of the National Lipid Association has regular teleconferences to support advocacy
and convey best practices. Guidelines for pediatric lipidology initially focused on
low-density lipoprotein cholesterol in 1992 as part of the National Cholesterol Education
Program. Today the most comprehensive coverage comes from the 2011 National Heart
Lung and Blood Institute Pediatric Guidelines. Universal screening was recommended
for children between ages 9 and 11 years and teenagers/young adults between 17 to
21 years, a position echoed as “may be recommended” by the 2018 AHA/ACC/Multisociety
Cholesterol Guidelines. While pediatric lipidologists continue to treat uncommon genetic
disorders, they increasingly confront an issue of epidemic proportions—dyslipidemia
as the initial presentation of metabolic dysregulation associated with obesity. Consequences
of such altered metabolism extend to atherosclerosis, diabetes, liver disease, and
other serious problems in adult life. Pediatric lipid science and practice differ
from adult experience in several ways, including importance of family and birth history
as well as genetics/epigenetics, lack of general pediatricians’ familiarity with lipid
drugs, value of family counseling, need for biomarkers of early metabolic dysregulation,
and anticipation of endpoints in adult life not fully defined by randomized clinical
trials in children.
Keywords
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Suggested reading
- Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute summary report.Pediatrics. 2011; 128: S213-S256
- Screening for lipid disorders in children and adolescents. U.S. Preventive Services Task Force Recommendation Statement.JAMA. 2016; 316: 625-633
- Familial hypercholesterolemia: screening, diagnosis and management of pediatric and adult patients: clinical guidance from the National Lipid Association Expert Panel on Familial Hypercholesterolemia.J Clin Lipidol. 2011; 5: 133-140
- The agenda for familial hypercholesterolemia. a scientific statement from the American Heart Association.Circulation. 2015; 132: 2167-2192
- Tracking dietary patterns over 20 years from childhood through adolescence into young adulthood: The Saskatchewan Pediatric Bone Mineral Accrual Study.Nutrients. 2017; 9: E990
- Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement.JAMA. 2017; 317: 2417-2426
- Efficacy and safety of lowering dietary intake of fat and cholesterol in children with elevated low-density lipoprotein cholesterol. The Dietary Intervention Study in Children (DISC).JAMA. 1995; 273: 1429-1435
- Prevalence of heterozygous familial hypercholesterolemia and combined hyperlipidemia phenotype in very young survivors of myocardial infarction and their association with the severity of atheromatous burden.J Clin Lipidol. 2019; 13: 502-508
- Effects of dietary fructose restriction on liver fat, de novo lipogenesis, and insulin kinetics in children with obesity.Gastroenterology. 2017; 153: 743-752
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© 2019 Published by Elsevier Inc. on behalf of National Lipid Association.
