Lipids and Heart in Children
Cholesterol and triglycerides are very important plasma lipids and are transported in the serum in the form of lipoproteins.
Cholesterol is mainly produced in the liver, while 15-20% comes from food intake. Triglycerides come from both the liver and food intake.
The disorder of the concentration of lipids in the serum (dyslipidemia) is one of the main parameters that contributes to the formation of atherosclerotic plaques on the walls of the body’s vessels and the coronary vessels of the heart. The formation of atherosclerosis begins in childhood and leads to the appearance of cardiovascular complications at a younger age during adulthood, approximately at 30 – 40 years of age.
Dyslipidemia may be due to genetic mutations of one or more genes in the synthesis, transport and metabolism of lipoproteins. This type of dyslipidemia is called primary and appears from childhood. However, dyslipidemia may be due to other conditions or diseases, in which case it is called secondary and which, in the pediatric population, may be obesity, medications, metabolic diseases such as hypothyroidism, diabetes mellitus, kidney and liver diseases, viral infections, juvenile rheumatoid arthritis, etc.
The association of dyslipidemia with body weight is clear. As body weight increases, serum lipid values also increase, and in the USA obese children have dyslipidemia at a rate of 43%.
The most common disorder in the pediatric population is low HDL (the so-called “good” cholesterol, which has a cardioprotective effect), elevated triglycerides and high LDL (the “bad” cholesterol).
Before the pediatrician or pediatric cardiologist requests lipid tests for a child, he or she should already know:
1. If there is a family history of coronary artery disease in young people <55 years old in men and women <65 years old, e.g. if the child’s parents have had a heart attack before these ages.
2. If there is already a known family history of a serious lipid disorder.
3. If there are predisposing factors for elevated lipid values or for cardiovascular diseases, e.g. obesity, diabetes mellitus, arterial hypertension, kidney diseases, liver, endocrine disorders, taking medications.
When is a child’s first cholesterol test performed?
If the three aforementioned reasons do not exist, the first lipid profile test of the child is performed between 9-11 years of age and then between 17-21 years of age. However, if the previous indications coexist, then the first test is performed at the age of 2 years.
It seems that in children, lipid values increase until pre-puberty and then decrease during puberty, while in girls the values are higher than in boys.
They receive medication if deemed necessary at an age older than 10 years.
Concluding this brief review, regarding the value of lipids in the heart health of children and young adults, we should emphasize that the early diagnosis of dyslipidemias and treatment with targeted nutrition, exercise, improvement of body weight and the addition of medication where indicated according to international guidelines is very important.
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