Lipid Profile, Fasting, Pediatric

Overview:

Assessment of cardiovascular health and risk stratification in pediatric, adolescent, and young adult populations.

Patients with obstructive liver disease may develop lipoprotein abnormalities.

Atherosclerosis begins in youth, and this process, from its earliest phases, is related to the presence and intensity of the known cardiovascular risk factors. Clinical events such as myocardial infarction, stroke, peripheral arterial disease, and ruptured aortic aneurysm are the culmination of the lifelong vascular process of atherosclerosis. The most important evidence relating risk in youth to clinical CVD is the observed association of risk factors for atherosclerosis to clinically manifest cardiovascular conditions. Genetic disorders related to high cholesterol are the biological model for risk-factor impact on the atherosclerotic process. Combined evidence from autopsy studies, vascular studies, and cohort studies strongly indicates that abnormal lipid levels in childhood are associated with increased evidence of atherosclerosis. The evidence review supports the concept that early identification and control of dyslipidemia throughout youth and into adulthood will substantially reduce clinical CVD risk beginning in young adult life. Significant evidence exists to indicate that using family history of premature CVD or cholesterol disorders as the primary factor in determining lipid screening for children misses ~30% to 60% of children with dyslipidemias, and accurate and reliable measures of family history are not available. In the absence of a clinical or historic marker, identification of children with lipid disorders that predispose them to accelerated atherosclerosis requires universal lipid assessment. Non-HDL cholesterol level has been identified as a significant predictor of the presence of atherosclerosis, as powerful as any other lipoprotein cholesterol measure in children and adolescents. For both children and adults, non-HDL cholesterol level seems to be more predictive of persistent dyslipidemia and, therefore, atherosclerosis and future events than TC, LDL cholesterol, or HDL cholesterol levels alone. A major advantage of non-HDL cholesterol is that it can be accurately calculated in a nonfasting state and is, therefore, practical to obtain in clinical practice.1

1. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report. Pediatrics. 2011 Dec; 128(Suppl 5):S213-S256. PubMed 22084329