Pediatric dyslipidemia - beyond familial hypercholesterolemia

Abstract Dyslipidemia is seen with increasing prevalence in young Canadians; this is mainly mild-to-moderate hypertriglyceridemia secondary to obesity. This review will focus on pediatric dyslipidemias excluding familial hypercholesterolemia (FH), but including both severe and mild-to-moderate hypertriglyceridemia, combined hyperlipidemia and elevated Lipoprotein(a) (Lp[a]). We suggest that for Canadian children and adolescents with dyslipidemia, atherosclerotic cardiovascular disease (ASCVD) risk assessment should include both LDL cholesterol and TG measurement. To further stratify risk, determination of non HDL cholesterol is recommended, both for its ability to predict ASCVD and convenience for the patient, since fasting is not required. Similarly, apo B measurement (fasting or non-fasting), where available, can be helpful. Lp(a) measurement should not be routine in childhood, but can be considered in special circumstances. After ruling out secondary causes, the foundation for management of pediatric dyslipidemia includes weight regulation, optimizing the diet and increasing the activity level. At present, randomized clinical trial data to guide pharmaceutical management of pediatric hypertriglyceridemia or other non-FH pediatric dyslipidemias are scarce. Pharmaceutical management should be reserved for special situations in which risk of complications such as acute pancreatitis or ASCVD over the intermediate term is high and conservative lifestyle-based interventions have been ineffective.