Belay B, Belamarich P, Racine AD: Pediatric precursors of adult atherosclerosis. Pediatrics in Review 2004;25(1):4-16.
In the last 10 years, research has expanded our understanding of the molecular pathogenesis of atherosclerosis in adults with the beginning realization that prevention begins in childhood. This article reviews the development of atherosclerotic plaque, epidemiology of coronary artery disease, latest proposed guidelines for evaluating children with pediatric hypercholesterolemia, and the risk factors to be considered: hypertension, obesity, diabetes, family history, smoking, physical activity, lipoprotein (a), homocysteine levels, and chlamydia infections.
The National Cholesterol Education Program and the American Academy of Pediatrics have proposed a two-pronged approach to manage children with hypercholesterolemia. The first approach is population-based, encouraging all children older than 2 years of age to consume low-fat diets: 30% of daily calories from fat and no more than 10% from saturated fat. The second approach is aimed at the individual patient and sets criteria for testing children born to families with adults who have hypercholesterolemia or coronary artery disease. These children should have a nonfasting total serum cholesterol level measured. Depending on results, these children may need dietary interventions and/or lipid-lowering medication.