Hyperlipidemia NCEP recommendations for drug therapy of high-risk hyperlipidemia in children and adolescents: Difference between revisions
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==Overview== | ==Overview== | ||
Children and adolescents with high-risk hyperlipidemia require lipid-lowering drug therapy, particularly those with familial hypercholesterolemia, despite compliance with lifestyle recommendations. | |||
Children and | ==NCEP Recommendations for Drug Therapy of High-Risk Hyperlipidemia in Children and Adolescents== | ||
===Original Recommendations of the National Cholesterol Education Program (NCEP) Expert Panel for Drug Therapy of High-Risk Hyperlipidemia in Children and Adolescents <ref name="pmid17377073">{{cite journal| author=McCrindle BW, Urbina EM, Dennison BA, Jacobson MS, Steinberger J, Rocchini AP et al.| title=Drug therapy of high-risk lipid abnormalities in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, with the Council on Cardiovascular Nursing. | journal=Circulation | year= 2007 | volume= 115 | issue= 14 | pages= 1948-67 | pmid=17377073 | doi=10.1161/CIRCULATIONAHA.107.181946 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17377073 }} </ref> (DO NOT EDIT)=== | |||
===Original Recommendations of the National Cholesterol Education Program (NCEP) Expert Panel for Drug Therapy of High-Risk Hyperlipidemia in Children and Adolescents <ref name="pmid17377073">{{cite journal| author=McCrindle BW, Urbina EM, Dennison BA, Jacobson MS, Steinberger J, Rocchini AP et al.| title=Drug therapy of high-risk lipid abnormalities in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, with the Council on Cardiovascular Nursing. | journal=Circulation | year= 2007 | volume= 115 | issue= 14 | pages= 1948-67 | pmid=17377073 | doi=10.1161/CIRCULATIONAHA.107.181946 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17377073 }} </ref> ( | |||
{{cquote| | {{cquote| | ||
* Consider drug therapy in children ≥ 10 years of age (usually wait until [[menarche]] for females) and after a 6- to 12-month trial of fat- and cholesterol-restricted dietary management. | |||
* Consider drug therapy in | |||
* Consider drug therapy if | * Consider drug therapy if | ||
** [[LDL]] level remains | ** [[LDL]] level remains ≥ 4.90 mmol/L (190 mg/dL) or | ||
** [[LDL]] remains | ** [[LDL]] remains > 4.10 mmol/L (160 mg/dL) and there is a positive family history of premature cardiovascular disease or ≥ 2 other risk factors are present in the child or adolescent after vigorous attempts to control these risk factors. | ||
* Referral to specialized lipid center may be deemed appropriate. | * Referral to specialized lipid center may be deemed appropriate. | ||
* | * Treatment goal | ||
** Minimal, LDL | ** Minimal, LDL < 3.35 mmol/L (130 mg/dL) | ||
** Ideal, LDL | ** Ideal, LDL < 2.85 mmol/L (110 mg/dL) | ||
}} | }} | ||
===Current Modifications of the National Cholesterol Education Program (NCEP) Expert Panel for Drug Therapy of High-Risk Hyperlipidemia in Children and Adolescents <ref name="pmid17377073">{{cite journal| author=McCrindle BW, Urbina EM, Dennison BA, Jacobson MS, Steinberger J, Rocchini AP et al.| title=Drug therapy of high-risk lipid abnormalities in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, with the Council on Cardiovascular Nursing. | journal=Circulation | year= 2007 | volume= 115 | issue= 14 | pages= 1948-67 | pmid=17377073 | doi=10.1161/CIRCULATIONAHA.107.181946 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17377073 }} </ref> (DO NOT EDIT)=== | |||
{{cquote| | |||
* In addition to family history, overweight and [[obesity]] should trigger screening with a fasting [[lipid profile]]. | |||
* [[Overweight]] and obese children with lipid abnormalities should be screened for other aspects of the [[metabolic syndrome]] (i.e., [[insulin resistance]] and [[type 2 diabetes]], [[hypertension]], or [[central adiposity]]). | |||
* For children meeting criteria for starting lipid-lowering drug therapy, a [[statin]] is recommended as first-line treatment. | |||
* For children with high-risk lipid abnormalities, the presence of additional risk factors or high-risk conditions may also lower the recommended cutpoint LDL cholesterol level for initiation of drug therapy, lower the desired target LDL cholesterol levels, and in selected cases, may prompt consideration for initiation below the age of 10 years. These risk factors and high-risk conditions may include: | |||
** Male gender | |||
** Strong family history of [[premature cardiovascular disease]] or events | |||
** Presence of associated low [[high-density lipoprotein]] ([[HDL]]), high [[triglycerides]], small dense [[LDL]] | |||
** Presence of overweight or obesity and aspects of the metabolic syndrome | |||
** Presence of other medical conditions associated with an increased atherosclerotic risk such as [[diabetes]], [[human immunodeficiency virus]] (HIV) infection, [[systemic lupus erythematosus]], organ [[transplantation]], survivors of childhood [[cancer]] | |||
** Presence of [[hypertension]] | |||
** Current [[smoking]] and passive smoke exposure | |||
** Presence of novel and emerging risk factors and markers, e.g., elevated lipoprotein(a), [[homocysteine]], [[C-reactive protein]] | |||
* Ongoing research of drug therapy of high-risk lipid abnormalities in children is needed, particularly with regard to long-term efficacy and safety, and impact on the atherosclerotic disease process. | |||
}} | |||
==References== | ==References== | ||
{{reflist}} | {{reflist|2}} | ||
{{Metabolic pathology}} | {{Metabolic pathology}} | ||
Latest revision as of 18:56, 19 February 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Lipoprotein Disorders Microchapters |
Overview
Children and adolescents with high-risk hyperlipidemia require lipid-lowering drug therapy, particularly those with familial hypercholesterolemia, despite compliance with lifestyle recommendations.
NCEP Recommendations for Drug Therapy of High-Risk Hyperlipidemia in Children and Adolescents
Original Recommendations of the National Cholesterol Education Program (NCEP) Expert Panel for Drug Therapy of High-Risk Hyperlipidemia in Children and Adolescents [1] (DO NOT EDIT)
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Current Modifications of the National Cholesterol Education Program (NCEP) Expert Panel for Drug Therapy of High-Risk Hyperlipidemia in Children and Adolescents [1] (DO NOT EDIT)
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References
- ↑ 1.0 1.1 McCrindle BW, Urbina EM, Dennison BA, Jacobson MS, Steinberger J, Rocchini AP; et al. (2007). "Drug therapy of high-risk lipid abnormalities in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, with the Council on Cardiovascular Nursing". Circulation. 115 (14): 1948–67. doi:10.1161/CIRCULATIONAHA.107.181946. PMID 17377073.