Reduction of Low-Density Lipoprotein Cholesterol by Dietary Intervention in Children at High Risk for Premature Coronary Artery Disease

The identification and treatment of children with elevated low-density lipoprotein (LDL) cholesterol levels is considered to be a high priority in any initiative to reduce the risk of premature coronary artery disease (CAD). Children who would benefit most from such treatment often have a strong family history of premature CAD. In the present study, 54 subjects in 35 families met the following criteria: they were identified through a parent with symptomatic atherosclerotic CAD and/or a strong family history of early CAD: they were between the ages of 2 and 19 years; they had fasting LDL cholesterol level above the normal range defined as greater than the 90th percentile for an age-matched control population (>120 mg/dl). At visit 1, they were counseled to follow a dietary regimen that would reduce dietary cholesterol intake to 200-250 mg/day, reduce fat intake to 30% of total calories, and increase the polyunsaturated : saturated fat ratio to 1 : 1. At visit 2, 1-12 months later (6.7 ±3.4 months), plasma lipid levels were again measured. There was a highly significant reduction in LDL cholesterol level in the group, from 170 ± 50 to 150 ± 49 mg/dl (paired t = 6.68, P 200 mg/dl), the reduction in LDL cholesterol level, although similar to that for the rest of the group, was not sufficient to put them into the normal range. No significant reduction in the plasma apolipoprotein-B level was observed.