Treatment of Dyslipidaemia in Children

Abstract

Childhood dyslipidaemia is one of the main traditional cardiovascular risk factors that initiate and exacerbate the atherosclerotic process. Healthcare providers may play a key role in the management of children with lipid abnormalities; however, they have to properly evaluate the normal lipid values and know the available treatment options in children and adolescents. Current guidelines recommend healthy behaviours as the first-line treatment for childhood dyslipidaemia. The therapeutic lifestyle changes should focus on dietary modifications, daily physical activity, reduction in body weight and tobacco smoking cessation. Parents play a key role in promoting their children’s healthy habits. In children with more severe forms of lipid abnormalities and in those who do not benefit from healthy behaviours, pharmacological therapy should be considered. Safe and effective medications are already available for children and adolescents. Statins represent the first-line pharmacological option, while ezetimibe and bile acid sequestrants are usually used as second-line drugs. Despite their limited use in children, other lipid-lowering agents (already approved for adults) are currently available or under study for certain categories of paediatric patients (e.g., familial hypercholesterolemia). Further studies are needed to evaluate the long-term efficacy, safety and tolerability of novel lipid-lowering drugs, especially in children.

Dyslipidemia Diagnosis and Treatment: Risk Stratification in Children and Adolescents

“…The therapeutic approach and therapeutic goals depend on the risk of developing atherosclerotic CVD, and the criteria are more restricted for those at high risk (Figures 2 and 3 ) [ 48 , 49 ]. It aimed to reduce CVD risk in the future; thus, treatment criteria will depend primarily on LDL values.…”

“…The treatment basis is focused on diet and at least 30–60 min of physical activity [ 1 , 48 , 49 ]. Tobacco smoke exposure (passive or active) should be avoided and age-appropriate sleeping habits should be adopted.…”

“…Tobacco smoke exposure (passive or active) should be avoided and age-appropriate sleeping habits should be adopted. Additionally, screen time should be limited to <2 h per day since some studies observed that every additional hour was correlated with increased TG and decreased HDL levels [ 48 ]. These interventions should be family-centered to optimize their impact and length [ 16 ].…”

“…Dietary treatment of hypercholesterolemia is not indicated below 2 years of age due to the increased need for dietary fats (rapid growth and development of the nervous system) [ 42 , 48 ].…”

Synergistic Anti-Tumor Effect of Simvastatin Combined to Chemotherapy in Osteosarcoma

“…The administration of statins as therapy is topical as a first-line pharmacologic intervention for pediatric patients with severe dyslipidemias and/or at high risk of cardiovascular disease since the last few years [ 47 , 48 , 49 ]. In the adult population, the serious adverse events that could be associated with long-term statin therapy are myalgia, myopathy (muscle weakness associated with variations in serum concentrations of creatine kinase), and new-onset type 2 diabetes [ 50 ].…”