What are the guidelines for lipid management in children with hypercholesterolaemia in the UK?

From the Guidelines

In the UK, lipid management for children with hypercholesterolaemia follows a stepwise approach starting with lifestyle modifications before considering pharmacological treatment, with statins being the first-line medication for children aged 10 years and older with familial hypercholesterolaemia (FH) or those with LDL-cholesterol levels persistently above 3.5 mmol/L despite lifestyle changes, as recommended by the most recent guidelines 1.

Key Recommendations

• Children should first be encouraged to adopt a healthy diet low in saturated fats, increase physical activity, and maintain a healthy weight for at least 6-12 months.
• If these measures are insufficient, statins are considered, typically starting with low doses such as atorvastatin 10mg daily or rosuvastatin 5mg daily, with gradual titration based on response and tolerability.
• Treatment targets include reducing LDL-cholesterol by at least 50% from baseline or achieving levels below 3.5 mmol/L.
• Regular monitoring is essential, including liver function tests and creatine kinase levels before starting treatment and periodically thereafter.

Considerations for Pharmacological Treatment

• Statin therapy should be considered for children aged 10 years and older with LDL-C > 190 mg/dL or LDL-C > 160 mg/dL with other risk factors present, as per the guidelines 1.
• For children with homozygous FH or severe hypercholesterolaemia unresponsive to statins, additional treatments like ezetimibe, bile acid sequestrants, or referral to specialized lipid clinics may be necessary.
• The decision to start pharmacological treatment should be made in collaboration with a lipid specialist and take into account the child's overall cardiovascular risk profile.

Lifestyle Modifications

• A healthy diet low in saturated fats and high in fruits, vegetables, and whole grains is recommended.
• Increased physical activity, such as at least 1 hour of moderate-to-vigorous physical activity per day, is also recommended.
• Maintaining a healthy weight is crucial, and weight management programs may be necessary for children who are overweight or obese.

Monitoring and Follow-up

• Regular follow-up appointments with a healthcare provider are necessary to monitor the child's lipid levels, liver function, and overall health.
• Adjustments to treatment may be necessary based on the child's response to therapy and any potential side effects.

From the Research

Guidelines for Lipid Management in Children with Hypercholesterolaemia in the UK

The guidelines for lipid management in children with hypercholesterolaemia in the UK are based on several studies and recommendations.

• The management of children and young people with heterozygous familial hypercholesterolaemia (FH) in the UK is addressed in a consensus statement that provides guidance on lifestyle and dietary advice, low-density lipoprotein cholesterol (LDL-C) targets, and lipid-lowering therapies 2.
• All guidelines for the management of heterozygous familial hypercholesterolaemia in children and young people recommend statins to lower LDL-cholesterol (LDL-C) concentrations, to reduce the individual's adult risk of developing cardiovascular disease (CVD) 3.
• The use of statins in children is considered safe, with no evidence of adverse effects on growth, pubertal development, or muscle or liver toxicity, and long-term follow-up indicates benefits with respect to lower CVD rates 3.
• Clinicians should consider prescribing statins for children with hypercholesterolaemia from the age of at least 10 years, and earlier if CVD risk is particularly high in the family, with the option to uptitrate statin dosage and use additional lipid-lowering therapies to achieve recommended LDL-C targets 3.
• Screening for familial hypercholesterolaemia in children is recommended, with universal screening of children between 1 and 9 years of age proposed as a strategy likely to be most effective in terms of sensitivity and specificity for the identification of children with familial hypercholesterolaemia 4.
• The treatment of children and adolescents with familial hypercholesterolaemia should aim to reduce elevated total cholesterol and LDL-c levels, and avoid the risk of early cardiovascular diseases, with nutritional and medical therapies available 5.
• Available treatments for lowering low-density lipoprotein cholesterol (LDL-C) levels include statins, ezetimibe, bile acid sequestrants, and combinations, with statins being the most potent drugs for lowering LDL-C and well tolerated in most patients 6.