Identifying and treating dyslipidemia in childhood, which is linked with atherosclerosis later in life, could reduce cardiovascular risk in adulthood, researchers reported in a study recently published in the Journal of Nutrition and Metabolism.
The research team reviewed the medical literature on pediatric dyslipidemia to determine practical and structural approaches to treating the disease.
Many pathologies can contribute to dyslipidemia, including lysosomal acid lipase deficiency. These pathologies can broadly be categorized into 2 groups: primary dyslipidemia and secondary dyslipidemia. Primary dyslipidemia is caused by various genetic pathologies; secondary dyslipidemia is caused by exogenous conditions that negatively impact changes in lipid metabolism.
The initial diagnostic approach is to thoroughly review a patient’s medical and family histories. Health measurements, such as body mass index, abdominal perimeter, and blood pressure, should be carried out. A thorough physical examination may yield further physical signs, such as the presence of xanthomas, xanthelasmas, or corneal arch.
There is some debate on how screening should be performed, including arguments on its universality and its speed. However, there is consensus that dyslipidemia should be investigated thoroughly until physicians can be sure of its cause. The list of investigations to arrive at this point may be extensive, depending on the complexity of the case.
Read more about lysosomal acid lipase deficiency etiology
The next important step is to come up with a list of differential diagnoses and work through them to rule out as many as possible.
Once a diagnosis is made, a concerted therapeutic strategy should be decided upon. Generally, there are a few treatment strategies that are employed in all patients with dyslipidemia. One is dietary intervention and lifestyle changes, such as reducing tobacco exposure, limiting screen time, and consuming a diet high in fruit, vegetables, and whole grains.
Potential pharmacological interventions that can be introduced include statins, which represent the first-line treatment for dyslipidemia. Bile duct scavengers, such as cholestyramine, bind to bile acids and hence reduce their absorption. Cholesterol absorption inhibitors, such as ezetimibe, inhibit intestinal cholesterol absorption.
The research team concluded, “Atherosclerosis is a dynamic and inflammatory process; however, it can be modified, which highlights the importance of early intervention.”
Mosca S, Araújo G, Costa V, et al. Dyslipidemia diagnosis and treatment: risk stratification in children and adolescents. J Nutr Metab. 2022;2022:4782344. doi:10.1155/2022/4782344