What are the ACC/AHA guidelines AACE/ACE treatment guidelines for dyslipidemia and prevention of CVD for children and adolescents?

Updated: Jun 27, 2019
  • Author: Henry J Rohrs, III, MD; Chief Editor: Stuart Berger, MD  more...
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Answer

The AACE/ACE guidelines for management of dyslipidemia and prevention of CVD for children and adolescents recommends pharmacotherapy for those older than 10 years who do not respond sufficiently to lifestyle modification, particularly for those satisfying the following criteria [3]

  • LDL-C ≥190 mg/dL, or
  • LDL-C ≥160 mg/dL and the presence of two or more cardiovascular risk factors, even after vigorous intervention, or
  • Family history of premature ASCVD (age < 55 y), or
  • Having overweight, obesity, or other elements of the insulin resistance syndrome

Consider the following factors when prescribing low-fat diets for children and adolescents [3] :

  • Total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) levels are positively correlated in individuals aged 20 years and younger, and low-fat diets that decrease TC levels have also been associated with HDL-C reductions.
  • Increased intake of carbohydrates may increase plasma triglyceride (TG) concentrations in children. High carbohydrate intake is not recommended for children with hypertriglyceridemia.
  • Fish oil supplements have a profound effect on serum TG levels in children. These supplements have been used effectively in young individuals with end-stage renal insufficiency
  • Water-soluble fiber can help improve serum cholesterol levels in children. Studies have shown that both children and adults can achieve cholesterol reductions with high-fiber, low-fat diets
  • Diets supplemented with plant stanols and sterols can reduce LDL-C in children. Studies indicate that both children and adults can achieve LDL-C reduction between 5 and 10% by eating foods that are supplemented with plant stanols and sterols (eg, spreads/ margarines, orange juice, yogurt drinks, cereal bars, and dietary supplements). The AACE concurs with the American Academy of Pediatrics (AAP) and AHA recommendations suggesting that dietary supplementation with plant stanols and sterols may be considered for children with severe hypercholesterolemia or those who are otherwise at high risk. The main safety concern is that plant stanols and sterols may reduce absorption of fat-soluble vitamins and beta-carotene; therefore, the AHA suggests monitoring fat-soluble vitamin status in children receiving supplementation.

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