PEDI LIPIDS

Question 1

Hazards of elevated lipids in children

Answer 1

Risk for becoming adults with dyslipidemia and increased risk for early CVD

Question 2

Universal guidelines for screening for lipid abnormality

Answer 2

Universal non-fasting screening for non-HDLc (order total and HDL) age 9-11, then age 17-21

Best to have lipid specialist decide on drug therapy

Look at family history but this is an insensitive predictor

Question 3

Define the role of non-HDL cholesterol in lipid screening

Answer 3

Non-HDL cholesterol seems to be more predictive of persistent dyslipidemia than TC, LDL, or HDL in both children and adults

No need for direct LDL measurement

Most studies have shown that measurement of apolipoprotein B and apolipoprotein A-1 for universal screening provides no additional advantage

Question 4

Describe medical mgt to treat dyslipidemia

Answer 4

CHILD-1  CHILD-2 (LDL or TG) plus lifestyle modifications for 6 months

Consider referral to dietician
Exclude secondary causes
Repeat fasting lipid profile
Medical therapy may be recommended depending on the response

Consult with a lipid specialist
TG ≥ 500 mg/dL or LDL ≥ 250
Age < 10 years