Cardiovascular Risk Associated with Dyslipidemias in Children

Abstract

Atherosclerosis begins in childhood and can be aggravated by dyslipidemias, such as hypercholesterolemia and hypertriglyceridemia, especially in the presence of obesity and metabolic syndrome. The infant lipid profile should be assessed with a fast of 8 to 9 hours. Primary dyslipidemias, usually genetic, include heterozygous familial hypercholesterolemia and homozygous hypercholesterolemia, with diagnosis based on LDL-c levels and family history. Treatment involves diet, physical activity, and statins, and may include ezetimibe and PCSK9 inhibitors in more severe cases. Hypertriglyceridemia’s can be mild to severe, with primary causes (such as familial chylomicronemia syndrome) or secondary causes (related to diet, endocrine disease, and medications). Combined dyslipidemia is common in children with obesity and insulin resistance. Treatment is based on lifestyle changes and, in more severe cases, the use of statins, fibrates, or omega-3s. Secondary dyslipidemias are associated with diseases such as diabetes, hypothyroidism, and lupus. Treating the underlying cause can normalize lipids, but medications may be indicated in cases of moderate or high risk. Early screening is essential and should be done universally between 9-11 and 17-21 years, and selectively between 2-8 and 12-16 years for children with risk factors. Early identification and management of these conditions are key to reducing cardiovascular risk in adulthood.