Chapters authored
Arterial Stiffness Assessment in Children with Familial Hypercholesterolemia
Familial hypercholesterolemia (FH) is the genetic disease which characterized by an increase of level total cholesterol and low density lipoproteins since childhood. The aim of the study was to assess arterial stiffness in children with heterozygous FH by measuring the pulse wave velocity (PWV) in the aorta. The study involved 118 children, 60 healthy children in the control group and 58 children with heterozygous FH in the main group. Both groups were divided into 3 age subgroups: 5–7 years old, 8–12 years old and 13–17 years old. The diagnosis of FH was made using British criteria by Simon Broome. The lipid profile was determined for all children, blood pressure was monitored daily with an estimate of the minimum, mean and maximum PWV (PWVmin, mean PWV, PWVmax) in aorta using oscillometric method. Correlation analysis in patients with FH revealed direct correlation between PWVmin, mean PWV and PWVmax with total cholesterol (r = 0.46, r = 0.46 and r = 0.464, respectively, p < 0.001). The study demonstrates an increase in the PWV in the aorta in children with FH compared with healthy peers from 8–12 years of age and a progression of arterial stiffness most significant in the group of 13–17 years.
Part of the book: Management of Dyslipidemia
Statins for Children with Familial Hypercholesterolemia
Familial hypercholesterolemia (FH) is the most common genetic disorder in the world. It is characterized by increased level of total cholesterol (TC), low-density lipoproteins (LDL-C) since childhood. The diagnosis and initiation of therapy are optimal in childhood before complications (aortic stenosis, atherosclerotic changes in the arterial walls) appear. The initiation of lipid-lowering therapy in FH since childhood is important to reduce the cumulative effect of LDL-C, to increase patient’s life expectancy. Statins are recommended as first-line drugs for treatment with monitoring of the recommended clinical, biochemical markers under the supervision of a physician. However, due to limited experience, there are differing opinions among clinicians regarding the age of initiation of lipid-lowering therapy. This review is an attempt to critically study the available data from the world literature concerning the use of statins in children with FH, their effectiveness, safety. It is important to determine the endpoints for determining the effectiveness of statins, such as lowering LDL-C, assessing the thickness of the intima-media complex. The frequency of occurrence of possible side effects in children is considered - diabetes mellitus, hepatotoxicity, muscle pain and others. There is a need to continue randomized trials to prove the lifelong benefit of low LDL-C in patients with FH.
Part of the book: Management of Dyslipidemia