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(Circulation. 2008;117:9-10.)
© 2008 American Heart Association, Inc.

Editorial

Challenges of Existing Pediatric Dyslipidemia Guidelines

Call for Reappraisal

Julia Steinberger, MD, MS; Aaron S. Kelly, PhD

From the Division of Cardiology, Department of Pediatrics, University of Minnesota, Minneapolis.

Correspondence to Julia Steinberger, MD, MS, Associate Professor of Pediatrics, University of Minnesota, MMC 94, 420 Delaware St SE, Minneapolis, MN 55455. E-mail stein055@umn.edu

Key Words: Editorials • lipids • lipoproteins • pediatrics

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Existing guidelines for screening and managing lipoprotein abnormalities in children and adolescents are based on a consensus document published over 15 years ago by the National Cholesterol Education Program (NCEP) Expert Panel on Blood Cholesterol Levels in Children and Adolescents.¹ This document was based on evidence that elevated levels of low-density lipoprotein (LDL) cholesterol are highly correlated with development of atherosclerotic cardiovascular disease (ASCVD) in adults and on pathological data suggesting that dyslipidemia in children and adolescents was associated with early arterial plaque development. The panel recommended 2 strategies to address abnormal lipoprotein levels in children: a population-based approach (dietary recommendations) and a targeted screening approach (selective screening based on family history of ASCVD and/or parental hypercholesterolemia). The guidelines recommended dietary and lifestyle interventions for children with elevated LDL cholesterol levels. They proposed that drug therapy only be considered when LDL cholesterol levels are 190 mg/dL or 160 mg/dL with concomitant ASCVD risk factors (2) or with a family history of ASCVD.

Article p 32

Since the initial publication of the existing guidelines, many significant challenges have emerged that deserve attention. First, accumulating data suggest that the guidelines significantly underestimated the number of children who would be targeted for lipoprotein screening. Second, the guidelines do not account for variations in lipids due to race, gender, and pubertal status, all of which are known to have a clinically relevant impact on lipoprotein values. Third, there is a singular focus on LDL cholesterol with no emphasis on high-density lipoprotein (HDL) cholesterol . . . [Full Text of this Article]

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