High Cholesterol in Children and Adolescents
Children have been tested and treated for hypercholesterolemia for more than 30 years. The National Cholesterol Education Program (NCEP) recommends the selective screening of children and adolescents, targeting those who would be at the highest risk of developing high cholesterol and cardiovascular disease later in life. Screening is recommended for children over 2 years of age and adolescents whose parents or grandparents had cardiovascular disease before the age of 55 years. In addition, testing is also advised for children whose parents have cholesterol levels greater than 240 mg/dL. NCEP classifies a high cholesterol as having a total cholesterol of over 200 mg/dL or low-density lipoprotein cholesterol (LDL) above 130 mg/dL.
The initial treatment of high blood cholesterol involves diet with institution of the American Heart Association Step 1 diet, which consists of less than 10% of total calories from saturated fat, less than 30% of total calories from fat, and less than 300 mg of cholesterol per day. If the lipid goals are not achieved, the Step 2 diet is instituted. At this stage, a dietician may be helpful in developing good diet strategies. Regular exercise is also recommended. Dietary Guidelines for Healthy Children is published by the American Heart Association.
If diet is ineffective, medication treatment is recommended for children older than 10 years of age who have an LDL level greater 190 mg/dL or an LDL level greater than 160 mg/dL and a positive family history of premature heart disease or two risk factors. The current drugs of choice are the bile acid sequestrants. The role of the selective cholesterol absorption inhibitor, Zetia (ezetimibe), which avoids the gastrointestinal side effects of the bile acid sequestrants, needs to be studied in children under the age of 10. Some of the effects the bile acid sequestrants may be minimized with the newer generation of bile acid sequestrants Welchol (colesevelam). The use of nicotinic acid and fibric acid derivatives is not recommended due to the lack of longterm safety data in adolsecents under the age of 16.
Although most treatment regimens have been limited to dietary intervention, statin use is increasing. Statins have been used in children since 1987. The available data indicates that statins can be useful and well tolerated.
______________________________________________________________
October 31, 2002 -- Bristol-Myers Squibb Company announced today that the U.S. Food and Drug Administration (FDA) has approved a new indication for Pravachol® (pravastatin sodium) for use in treating pediatric patients with heterozygous familial hypercholesterolemia (HeFH). The FDA approval of Pravachol for this new indication provides an additional treatment option for children ages 8 years and older who suffer from this condition and whose LDL cholesterol levels are above the indicated limits after an adequate trial of diet. Familial heterozygous hypercholesterolemia is an inherited disorder that causes very high cholesterol levels beginning at birth and significantly increases the risk of having a heart attack early in life. It is estimated that this condition affects 1 in 500 children.
