Dyslipidaemia

E78.9

• Description
• Diagnostic criteria
• Investigations
• General and supportive measures
• Medicine treatment
• Referral

DESCRIPTION

Dyslipidaemia is a broad term used to describe disorders of lipid metabolism that may be classified according to the Frederickson classification.

The three common types of dyslipidaemia are important because they are associated with an increased risk of cardiovascular disease due to atherosclerosis

DIAGNOSTIC CRITERIA

Children with severe hypercholesterolaemia may present with xanthomas or myocardial infarction but most children with hypercholesterolaemia will be asymptomatic in childhood.

Children should be screened for dyslipidaemia if any of the following are present:

• Family history of premature cardiac disease or dyslipidaemia
• A medical condition associated with dyslipidaemia: diabetes mellitus, nephrotic syndrome, liver disease, obesity.

INVESTIGATIONS

• Exclude causes of secondary hyperlipidaemia
• In most cases non-fasting total cholesterol is determined in children at risk.
  If level is higher than upper limit, lipid profile is done after 12 hours of fasting.
  • Upper limit of S-cholesterol and triglycerides: Total cholesterol 5.2 mmol/L.
  • Triglycerides (after 12 hours of fasting):
    • influenced by lifestyle – needs attention if > 1.68 mmol/L,
    • pancreatitis risk if > 10 mmol/L.

GENERAL AND SUPPORTIVE MEASURES

Manage secondary causes of hyperlipidaemia according to guidelines.
Schedule for integrated cardiovascular health promotion in children.

• Obesity
  • See Obesity .
• Blood pressure
  • With family history of hypertension < 55 years of age: routine BP measurement from 3 years of age once a year.
  • If BP ≥ 95th percentile for sex, age, and height percentile, follow up and investigate if persistently elevated.
• Diet
  • Refer to a dietician.
  • Learning healthy eating habits is an important preventative measure.
  • Moderate salt intake.
• Physical activity
  • Encourage active child-parent play.
  • Limit child’s sedentary behaviour such as time watching television and playing video computer games to a maximum of 2 hours per day or 14 hours per week.
  • Children should not be allowed to eat while watching television, i.e. “no grazing”.
  • Organised sport 5 times per week for at least 20–30 minute periods.
• Smoking
  • Encourage members of the household who smoke to stop.

MEDICINE TREATMENT

Consider medicine treatment only after failure of general and supportive measures to lower the cholesterol over 6-12 months.
Children should be at least 8 years of age for consideration of pharmacological intervention.
If LDL-C remains above 4.1 mmol/L in children with 2 or more risk factors, or above 4.9 mmol/L regardless of the presence of risk factors, refer to a paediatric specialist for consideration of statins:
Risk factors: smoking, hypertension, BMI >= 95th centile (z-score +1.96), HDL-C < 35 mg/dL, diabetes mellitus, renal disease, male sex.

• Statins, e.g.:
• Simvastatin, oral, 10 mg at night.

Secondary hypercholesterolaemia due to nephrotic syndrome

See Chapter 6 Nephrotic Syndrome .

REFERRAL

• Children with homozygous familial hypercholesterolaemia.
• Children with or inadequate response to statins.