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    An emerging dyslipidemia: Assessing future CV risk in children

    Assessing future cardiovascular risk in children

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    New research on the natural history of familial hypercholesterolemia, a genetic disorder present in 1/500 of the general population, has demonstrated the adverse effects of chronic long-term exposure to elevated low-density lipoprotein (LDL) cholesterol and has prompted new recommendations regarding its management.1

    In addition to cholesterol, and as a consequence of the obesity epidemic, triglycerides have emerged as an important lipid risk factor.

    The renewed recognition of the importance of early life experiences to future cardiovascular disease has led to the development of the Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, evidence-based guidelines on the management of lipid disorders in children.2,3

    This new guideline is the first comprehensive guideline update since 1992 and includes not only information on lipids but also on all pediatric cardiovascular risk factors.

    Dyslipidemia and atherosclerosis

    The demonstration of the relationship of cardiovascular risk factors measured post mortem to atherosclerosis in adolescents in the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study has been instrumental in justifying preventive cardiology efforts in childhood.4

    Analyses from the PDAY study have calculated that for every increase of 30 mg/dL of non-high-density lipoprotein (HDL) cholesterol, there is a significant increase in premature atherosclerosis measured in the coronary arteries and abdominal aorta.

    Lower HDL cholesterol also contributes to premature atherosclerosis. This is true for the earliest lesions of atherosclerosis (fatty streaks) seen in adolescence and for advanced lesions seen in young adulthood.

    Most important, the presence of several cardiovascular risk factors in the same person accelerates the process.


    Table 1: PDAY study risk score
    Having dyslipidemia in association with another risk factor such as obesity or tobacco use is particularly malignant. The cumulative effect of all the major risk factors in one person can be calculated using the PDAY risk score (Table 1).4 In childhood, the goal is to prevent atherosclerosis development.

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