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Cholesterol screening and statin use in children: a literature review

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Abstract

Atherosclerosis begins in childhood. Fatty streaks, the earliest precursor of atherosclerotic lesions, have been found in the coronary arteries of children of 2 years of age. Hypercholesterolaemia is a risk factor for coronary artery disease. Hypercholesterolaemia can be either primary, when it is characteristic of the main disease, or secondary when it occurs as a result of either a disease process or drug treatment. Given the risk of vascular disease, including myocardial infarction (MI), cerebrovascular accidents (CVA, also known as strokes), peripheral vascular disease (PVD) and ruptured aortic aneurysm, which may follow atherosclerosis, it is important to prevent or slow the early development of atherosclerotic lesions. This prevention necessitates the control of key risk factors such hypercholesterolaemia, dyslipidaemia, hypertension etc. However, at what point this prevention ought to occur, and in what form, is uncertain. Using pharmacological primary prevention for hypercholesterolaemia in the paediatric population is controversial. In an adult patient, hypercholesterolaemia warrants the initiation of a statin. Statins, also known as hydroxymethylglutaryl co-enzyme A inhibitors (or HMG-CoA inhibitors) act by altering cholesterol metabolism. In the paediatric population, the clinical course of vascular disease and the effect of altering this clinical course are less certain. This article reviews the published literature on hypercholesterolaemia in children and the use of statins as a treatment for dyslipidaemia in children. The US National Cholesterol Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents 2012 guidelines (NCEP guidelines) regarding the recognition and treatment of childhood dyslipidaemia are reviewed.

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Authors and Affiliations

  1. The Children’s Ark, Department of Paediatrics, University Hospital, Limerick, Ireland

    Karen King, Alan Macken & Clodagh S. O’Gorman

  2. Graduate Entry Medical School, University of Limerick, Limerick, Ireland

    Karen King, Alan Macken, Ophelia Blake & Clodagh S. O’Gorman

  3. National Children’s Research Centre, Crumlin, Dublin 12, Ireland

    Alan Macken & Clodagh S. O’Gorman

  4. Department of Biochemistry, University Hospital, Limerick, Ireland

    Ophelia Blake

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  1. Karen King
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  2. Alan Macken
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  4. Clodagh S. O’Gorman
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Correspondence to Karen King.

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King, K., Macken, A., Blake, O. et al. Cholesterol screening and statin use in children: a literature review. Ir J Med Sci 188, 179–188 (2019). https://doi.org/10.1007/s11845-018-1835-9

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