Guidelines for lipid screening in children and adolescents: bringing evidence to the debate.

The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8. .
PEDIATRICS (Impact Factor: 5.3). 07/2012; 130(2):353-6. DOI: 10.1542/peds.2012-1137
Source: PubMed
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    ABSTRACT: Familial hypercholesterolemia (FH) is the most common genetic disorder causing premature cardiovascular disease and death. Heterozygous FH conservatively affects approximately 1:500 Canadians, and the more serious homozygous form affects approximately 1:1,000,000 Canadians, although these numbers might be underestimated. Of approximately 83,500 Canadians estimated to have FH, most are undiagnosed, which represents a simultaneous public health deficit and opportunity, because early treatment of heterozygous FH can normalize life expectancy. Diagnostic algorithms for FH incorporate increased plasma low-density lipoprotein cholesterol, pathognomonic clinical features, and family history of early cardiovascular disease and hyperlipidemia. DNA-based detection of causative mutations in FH-related genes can help with diagnosis. Maximizing diagnosis and treatment of FH in Canada will involve a multipronged approach, including: (1) increasing awareness of FH among health care providers and patients; (2) creating a national registry for FH individuals; (3) setting standards for screening, including cascade screening in affected families; (4) ensuring availability of standard-of-care therapies, in particular optimization of plasma low-density lipoprotein cholesterol levels and timely access to future validated therapies; (5) promoting patient-based support and advocacy groups; and (6) forming alliances with international colleagues, resources, and initiatives that focus on FH. This document aims to raise awareness of FH nationally, and to mobilize knowledge translation, patient support, and availability of treatment and health care resources for this underrecognized, but important medical condition. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
    The Canadian journal of cardiology 12/2014; 30(12):1471-81. · 3.12 Impact Factor
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    ABSTRACT: Background: We aimed to assess absolute plasma-serum differences and differences in ranking of total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), and TC/HDLC ratio in children. Methods: We analysed data of 412 children participating in a Dutch birth cohort. TC, HDLC, and TC/HDLC ratio were determined in plasma at age 8 and 12 years and in serum at age 12 years. Results: Compared to serum, plasma TC at age 12 years was 0.07 mmol/l lower (95% CI -0.08 to -0.06), plasma HDLC was 0.06 mmol/l higher (95% CI 0.05-0.07), and plasma TC/HDLC ratio was 0.19 lower (95% CI -0.20 to -0.17) (p < 0.0001). Intraclass correlation coefficients (ICCs) for ranking of TC, HDLC, and TC/HDLC ratio at age 12 years were 0.970, 0.745, and 0.979, respectively. ICCs for ranking of 8- to 12-year change of TC, HDLC, and TC/HDLC ratio were 0.971, 0.957, and 0.955, respectively. Conclusions: Cholesterol was systematically different in plasma and serum, and use of plasma would result in a more favourable lipid profile of children (lower TC, higher HDLC, and lower TC/HDLC ratio). Nevertheless, consistency in ranking of children according to plasma or serum cholesterol concentrations was very high. Age-related change in cholesterol can be validly assessed by ranking the difference between serum concentrations at one age and plasma concentrations at another age. © 2014 S. Karger AG, Basel.
    Annals of Nutrition and Metabolism 02/2014; 63(4):305-310. · 1.66 Impact Factor
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    ABSTRACT: The purpose of this study is to review the National Heart Lung and Blood Institute (NHBLI) guidelines on screening and management of hyperlipidemia in children and to discuss the critics concerns regarding universal screening. Data derived from the National Health and Nutrition Examination Survey has shown favorable trends in serum lipid levels among children and adolescents aged 6-19 years between 1988-1994 and 2007-2010. Mean total cholesterol (TC) decreased from 165 to 160 mg/dl, and the prevalence of elevated TC decreased from 11.3 to 8.1%. However, between 2007 and 2010, approximately 20% of children aged 9-11 years had either low high-density lipoprotein cholesterol (HDL-C) or high non-HDL-C This warrants additional evaluation as per the NHBLI guidelines. The NHBLI guidelines present physicians with a balanced perspective for screening and managing hyperlipidemia in children. These guidelines provide a schematic approach that helps primary care physicians to make treatment decisions. The hope is that this will lead to decreased healthcare system expense and overall improved health through early identification and intervention.
    Current opinion in pediatrics 02/2014; · 2.74 Impact Factor