6/29/15
On Monday, I was given the chance to talk to a patient who was new to treatment for her hyperlipidemia. She had a lot of questions about her new statin and mentioned all of her children had used Zetia while they were children. She was wondering why she was prescribed a statin rather than Zetia like her children had. I had never encountered a child who has used therapy for hyperlipidemia so I wanted to look up the guidelines for the pediatric population.
I looked at the American Academy of Pediatrics for reference on the issue. As for nutrient recommendations no diet restriction is recommended for those <2 years of age because that is when growth and development require the highest energy intakes. They recommend that by 5 years of age their diet should contain <20% from fat.
Screening recommendations for children are as follows:
1. Screen children and adolescents whose parents or grandparents at <55 years of age underwent an arteriography and were found to have diagnostic coronary arteriography.
2. Screen children and adolescents whoe parents or grandparents at <55 year of age had a documented MI, angina, PVD, CVD, or sudden cardiac death
3. Screen if parent has cholesterol level >240mg/dL
4. Screen if parental history is unobtainable especially with other risk factors
If the initial level is >200 a fasting test should be done to obtain HDL/LDL. If the total cholesterol is 170-199 a second measurement should be obtained and averaged with the first measurement.
Drug Therapy
Only consider for children >10 years after an adequate diet trial for 6-12 months whose LDL is >190 or whose LDL is >160 and there is a family history of cardiovascular disease or 2 or more risk factors are present in the child.
Recommended first line therapy is: bile acid sequentrants
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