Hypercholesterolemia in children

Davidson, M. H., Dugan, L. D., Burns, J. H., Sugimoto, D., Story, K., and Drennan, K. (1996). A psyllium-enriched cereal for the treatment of hypercholesterolemia in children A controlled, double-blind, crossover study. Am. ]. Clin. Nutr. 63, 96-102. 

B-Sitosterol - Recent reports demonstrated the efficacy of P-sitosterol in lowering plasma LDL-C in patients with Type II hyperlipoproteinemia. "" 3-Sitosterol obtained from tall oil was found to be effective at 3 g/day, a dose substantially lower than that required with older preparations. However, in juvenile Type II hyperlipoproteinemia, 3-sitosterol lowered LDL-C by only 6% but, in addition, decreased HDL-C by 15% thus, 3-sitosterol was not recommended for the treatment of hypercholesterolemia in children." A potential problem with 3-sitosterol is the increased risk of gallstone formation, in view of the finding of Increased saturation index of bile in patients given 3 g/day of plant sterols. ... 

McCrindle BW, O Neill MB, Cullen-Dean G, Helden E. Acceptability and compliance with two forms of cholestyramine in the treatment of hypercholesterolemia in children A randomized, crossover trial. J Pediatr 1997 130 266-273. 

Lambert M, Lupien PJ, Gagne C, et al. Treatment of familial hypercholesterolemia in children and adolescents Effect of lovastatin. Canadian Lovastatin in Children Study Group. Pediatrics 1996 97 619-628. 

Rausen, a. R., and D. Adlersberg Idiopathic (hereditary) hyperlipemia and hypercholesterolemia in children. Pediatrics 28, 276 (1961). 

Becker, M, Staab, D and Von Bergman, K (1992) Long-term treatment of severe familial hypercholesterolemia in children effect of sitosterol and benzafibrate. Pediatrics, 89, 138-142. 

Sorensen, K. E., Celermajer, D. S., Georgakopoulos, D., Hatcher, G., Betteridge, D. J., and Deanfield, J. E., Impairment of endothelium-dependent dilation is an early event in children with familial hypercholesterolemia and is related to the lipoprotein(a) level. J. Clin. Invest. 93, 50-55 (1994). 

Reductase inhibitors are useful alone or with resins, niacin, or ezetimibe in reducing levels of LDL. Women with hyperlipidemia who are pregnant, lactating, or likely to become pregnant should not be given these agents. Use in children is restricted to selected patients with familial hypercholesterolemia or familial combined hyperlipidemia. 

In addition, Nakao et al. have examined the effects of mood states on persistent versus temporary hypercholesterolemia in students entering a university [29]. They found that depressive mood appeared to relate to hypercholesterolemia when the university students were screened with tension-anxiety, depression, anger-hostility, vigor, fatigue, and confusion scales [29]. In children, after covariance adjustment for age, race, and sex, Glueck et al. pointed out that children having adjustment disorders with depression had much lower covariance-adjusted TC values than control... 

Nephrotic syndrome is a clinical and laboratory syndrome defined by heavy proteinuria (exceeding 3.5 g/1.73 m2 of body surface area in adults, or 40 mg/hr/m2 in children), accompanied by hypoproteinemia (mainly hypoalbuminemia), hypercholesterolemia (in severe cases also hypertriacylglycerolemia), lipiduria, and edema. 

McCrindle, B.W., Helden, E., and Conner, W.T. 1998. Garlic extract therapy in children with hypercholesterolemia. Arch. Pediatr. Adolesc. Med. 152, 1089—1094. 

The avidity of VLDL and LDL for vitamins E and K is very high. In fact, in persons with very high blood VLDL or LDL levels, these vitamins may move from the tissues to the bloodstream. Vitamin E deficiency has been observed in children with hereditary hypercholesterolemia (very high blood LDL levels). 

Currently promoted uses of OEP include EFA deficiency mastalgia, fibrocystic breast disease, endometriosis, menopause, premenstrual syndrome (PMS), and the prevention of preeclampsia, diabetic neuropathy, psoriasis, eczema/dermatitis, rheumatoid arthritis, cardiovascular disease, gastrointestinal disorders, attention deficit disorder in children, and hypercholesterolemia (5,7). OEP is used topically as an ingredient in some soaps, cosmetics and medicinals. 

Napoli C, Glass CK, Witztum JL, Deutch R, D Armiento FP, Palinski W. 1999. Influence of maternal hypercholesterolemia during pregnancy on progression of early atherosclerotic lesions in childhood fate of early lesions in children (FELIC) study. Lancet 354 1234-41... 

The NCEP/Expert Panel on Blood Cholesterol Levels in Children and Adoiescents and the American Academy of Pediatrics defined high cholesterol as concentrations more than the 95th percentile for total and LDL cholesterol in children and adolescents from families with hypercholesterolemia or premature vascular disease (see Table 26-18). Borderline total and LDL cholesterol concentrations are defined as values between the 75th and 95th percentiles. The NCEP panel referred to total and LDL cholesterol values below the 75th percentile as "desirable. Low HDL cholesterol was also defined as a concentration below 35 mg/dL. Children tend to have higher HDL cholesterol concentra-... 

The Total Plasma and LDL-Cholesterol Levels in Children and Adolescents from Families with Hypercholesterolemia or Premature Cardiovascular Disease ... 

Since calcium antagonists are used extensively for the treatment of coronary artery disease (8), the present study has potential clinical implications. Unlike anticalcifying drugs (2- 7), calcium antagonists are not known to affect bone mineralization, and might be evaluated in children with familial hypercholesterolemia. 

Dietary Cholesterol and P/S Ratio The low dietary cholesterol and modest P/S ratio in our patients provided a reasonable but not maximal conventional dietary approach to controlling hypercholesterolemia. The mean intake in children of 161 mg/day and P/S of. 58 compares to USDA figures of 370 mg/day of cholesterol and P/S of. 36 for children. Adults consumed 242 mg/day and P/S of. 56 as compared to national norms for adults of 451 mg/day of cholesterol and P/S ratio of. 22.28-29 jhe changes in cholesterol, LDL-C, HDL-C, and VLDL-C attributed to the LBG food products were in addition to the presumed effect of the baseline diet which was not altered significantly during the study. It is not known what the effect of LBG food products would be on a similar group whose baseline diet included average cholesterol and P/S intake. 

Rodenburg J, Vissers MN, Wiegman A et al. Oxidized low-density lipoprotein in children with famhial hypercholesterolemia and unaffected siblings Effect of pravastatin. 

Susceptibility factors Age Guidehnes for statin therapy in children with familial hypercholesterolemia have been developed in recent years. The safety of increasing dosages of rosuvastatin has been reported in 177 children aged 10-17 years. The highest dose recommended for children, 20mg/day, lowered LDL cholesterol by 50% [27. ... 

From studies of approximately 1500 cases from 150 families which have appeared during the past 10 years, it is apparent that marked hypercholesterolemia and xanthomatosis may be found in children, and death from coronary heart disease may occur before the age of 10 (see page 419). In the great majority of subjects who are to develop EFH, hypercholesterolemia is present by that age. 

The serum cholesterol-lowering effect of plant sterols and stanols has been proven in several clinical studies. The hypocholesterolemic effects have been verified in normocholesterolemic individuals, in individuals with mild to moderate hypercholesterolemia or with familial hypercholesterolemia, in women with coronary heart disease, and in men with non-insulin-dependent diabetes -in conjunction with cholesterol-lowering statin therapy and irrespective of the background diet. In addition, studies have been conducted with normocholesterolemic children and with children with slightly elevated cholesterol levels, or with familial hypercholesterolemia. 

---