Is elevated cholesterol in childhood associated with premature coronary artery disease?.To guide cholesterol management in pediatric practice, pediatricians need answers to several important questions: These recommendations have not been well implemented in pediatric practice, though the American Academy of Pediatrics recently re-endorsed them. More aggressive treatment is reserved for those with the highest levels of low-density lipoprotein (LDL) cholesterol. The NCEP recommends cholesterol screening for children with a positive family history of early myocardial infarction or elevated cholesterol. 2,8 According to the report, the daily diet of a child older than 2 years should comprise less than 30% fatof which no more than one third (10% of total energy intake) should be saturated fatand less than 300 mg of cholesterol. In 1992, the National Cholesterol Education Program (NCEP) issued a consensus report on the importance of reducing blood cholesterol in childhood. 2-4 This is so, even though recent public health programs to reduce cholesterol through diet and drug treatment have been successful, whereas efforts to prevent tobacco use, increase physical activity, and control obesity in children and adolescents have not been effective. Yet the importance of measuring and controlling the cholesterol level in children continues to produce heated commentary. The role of the pediatrician in blood pressure assessment, smoking prevention, the encouragement of physical activity, and the prevention of obesity arouses little controversy. 1 As a result, the spotlight is once again on how to prevent coronary artery disease (CAD) and lower cholesterol. By answering the questions that surround this issue, a pediatric cardiologist clarifies how to proceed.Īlthough mortality from cardiovascular disease steadily decreased from the 1960s to the early 1990s, these gains have reached a plateau. How best to manage cholesterol in pediatric practice remains controversial. Risks of having elevated cholesterol in childhood To screen or not to screen How high is too high? Treating high cholesterol Making the NCEP guidelines even better Here's to healthy hearts By Samuel S.
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