Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents: A Scientific Statement From the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, With the Council on Cardiovascular Nursing
Abstract
Despite compliance with lifestyle recommendations, some children and adolescents with high-risk hyperlipidemia will require lipid-lowering drug therapy, particularly those with familial hypercholesterolemia. The purpose of this statement is to examine new evidence on the association of lipid abnormalities with early atherosclerosis, discuss challenges with previous guidelines, and highlight results of clinical trials with statin therapy in children and adolescents with familial hypercholesterolemia or severe hypercholesterolemia. Recommendations are provided to guide decision-making with regard to patient selection, initiation, monitoring, and maintenance of drug therapy.
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Data suggest that care for type 1 diabetes has improved, as evidenced by reduced rates of microvascular disease in past decades, whereas data on cardiovascular disease suggest substantially less progress in reducing macrovascular disease rates.
“Furthermore, there are data to suggest that care for T1D has improved as evidenced by reduced rates of microvascular disease in the past decades109–111, whereas data on CVD suggest that substantially less progress has been made in reduction of macrovascular disease rates111–113.”
From Epidemiology of type 1 diabetes (2010) · cites this paper as [112]
The AHA categorizes type 1 children in the highest tier for cardiovascular risk and recommends both lifestyle and pharmacologic treatment for those with elevated LDL cholesterol levels.
“the AHA categorizes type 1 children in the highest tier for cardiovascular risk and recommends both lifestyle and pharmacologic treatment for those with elevated LDL cholesterol levels (285,286).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [286]
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Standards of medical care in diabetes—2014
American Diabetes Association (2014) · Diabetes Care · doi:10.2337/dc14-s014 · Cited by 4,572 · see citing works
Standards of medical care in diabetes—2013
American Diabetes Association (2013) · Diabetes Care · doi:10.2337/dc13-s011 · Cited by 4,369 · see citing works
Standards of medical care in diabetes 2010
American Diabetes Association (2010) · Diabetes Care · doi:10.2337/dc10-s011 · Cited by 3,470 · see citing works
Standards of medical care in diabetes—2011
American Diabetes Association (2011) · Diabetes Care · doi:10.2337/dc11-s011 · Cited by 2,880 · see citing works
Standards of Medical Care in Diabetes—2012
(2012) · Diabetes Care · doi:10.2337/dc12-s011 · Cited by 2,240 · see citing works
Standards of Medical Care in Diabetes—2009
American Diabetes Association (2009) · Diabetes Care · doi:10.2337/dc09-s013 · Cited by 2,167 · see citing works
Tabas, I., Williams, K. J., & Borén, J. (2007) · Circulation · doi:10.1161/circulationaha.106.676890 · Cited by 1,399 · see citing works
Lipid screening and cardiovascular health in childhood
Daniels, S. R., Greer, F. R., & and the Committee on Nutrition (2008) · Pediatrics · doi:10.1542/peds.2008-1349 · Cited by 1,178 · see citing works
Self-citationEpidemiology of type 1 diabetes
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Familial Hypercholesterolemia: Screening, diagnosis and management of pediatric and adult patients
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Self-citationLipshultz, S. E., Adams, M. J., Colan, S. D., Constine, L. S., Herman, E. H., Hsu, D. T., Hudson, M. M., Kremer, L. C. M., Landy, D. C., Miller, T. L., et al. (2013) · Circulation · doi:10.1161/cir.0b013e3182a88099 · Cited by 614 · see citing works
Self-citationJellinger, P. S., Smith, D. A., Mehta, A., Ganda, O. P., Handelsman, Y., Rodbard, H. W., Shepherd, M. D., & Seibel, J. A. (2012) · Endocrine Practice · doi:10.4158/ep.18.s1.1 · Cited by 527 · see citing works
Type 1 Diabetes Mellitus and Cardiovascular Disease
de Ferranti, S. D., de Boer, I. H., Fonseca, V. A., Fox, C. S., Golden, S. H., Lavie, C. J., Magge, S. N., Marx, N., McGuire, D. K., Orchard, T. J., et al. (2014) · Circulation · doi:10.1161/cir.0000000000000034 · Cited by 504 · see citing works
de Ferranti, S. D., Steinberger, J., Ameduri, R. K., Baker, A., Gooding, H. C., Kelly, A. S., Mietus‐Snyder, M., Mitsnefes, M. M., Peterson, A. L. H., St‐Pierre, J., et al. (2019) · Circulation · doi:10.1161/cir.0000000000000618 · Cited by 448 · see citing works
Self-citationde Ferranti, S. D., de Boer, I. H., Fonseca, V. A., Fox, C. S., Golden, S. H., Lavie, C. J., Magge, S. N., Marx, N., McGuire, D. K., Orchard, T. J., et al. (2014) · Diabetes Care · doi:10.2337/dc14-1720 · Cited by 434 · see citing works
14. Children and Adolescents: Standards of Medical Care in Diabetes—2022
(2021) · Diabetes Care · doi:10.2337/dc22-s014 · Cited by 379 · see citing works
Watts, G. F., Gidding, S. S., Wierzbicki, A. S., Toth, P. P., Rodrigo Alonso, K., Brown, W. V., Bruckert, É., Defesche, J. C., Lin, K. K., Livingston, M., et al. (2013) · International Journal of Cardiology · doi:10.1016/j.ijcard.2013.11.025 · Cited by 377 · see citing works
13. Children and Adolescents: Standards of Medical Care in Diabetes−2020
American Diabetes Association (2019) · Diabetes Care · doi:10.2337/dc20-s013 · Cited by 272 · see citing works
Statins for children with familial hypercholesterolemia
Vuorio, A. F., Kuoppala, J., Kovanen, P. T., Humphries, S. E., Tonstad, S., Wiegman, A., Drogari, E., & Ramaswami, U. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006401.pub4 · Cited by 265 · see citing works
Garber, A. J., Handelsman, Y., EINHORN, D. F., Bergman, D. A., Bloomgarden, Z. T., Fonseca, V. A., Garvey, W. T., Gavin, J. R., Grunberger, G., Horton, E. S., et al. (2008) · Endocrine Practice · doi:10.4158/ep.14.7.933 · Cited by 235 · see citing works
13. Children and Adolescents: <i>Standards of Medical Care in Diabetes—2021</i>
American Diabetes Association (2021) · Diabetes Care · doi:10.2337/dc21-s013 · Cited by 223 · see citing works
2018 Guidelines for the management of dyslipidemia
Rhee, E., Kim, H. C., Kim, J. H., Lee, E. Y., Kim, B. J., Kim, E. M., Song, Y., Lim, J. H., Kim, B. J., Choi, S., et al. (2019) · The Korean Journal of Internal Medicine · doi:10.3904/kjim.2019.188 · Cited by 217 · see citing works
Besseling, J., Kindt, I., Hof, M. H. P., Kastelein, J. J. P., Hutten, B. A., & Hovingh, G. K. (2014) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2013.12.020 · Cited by 212 · see citing works
Reduction of Risk for Cardiovascular Disease in Children and Adolescents
Daniels, S. R., PRATT, C. A., & Hayman, L. L. (2011) · Circulation · doi:10.1161/circulationaha.110.016170 · Cited by 206 · see citing works
Self-citationFamilial hypercholesterolaemia: A model of care for Australasia
Watts, G. F., SULLIVAN, D. R., Poplawski, N. K., van Bockxmeer, F., Hamilton‐Craig, I. R., Clifton, P. M., O’Brien, R. C., Bishop, W., George, P. M., Barter, P. J., et al. (2011) · Atherosclerosis Supplements · doi:10.1016/j.atherosclerosissup.2011.06.001 · Cited by 205 · see citing works
14. Children and Adolescents: Standards of Care in Diabetes—2023
ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Hilliard, M. E., Isaacs, D. M., Johnson, E. L., et al. (2022) · Diabetes Care · doi:10.2337/dc23-s014 · Cited by 210 · see citing works
13. Children and Adolescents: Standards of Medical Care in Diabetes—2019
American Diabetes Association (2018) · Diabetes Care · doi:10.2337/dc19-s013 · Cited by 200 · see citing works
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Cardiovascular Disease Risk Factors in Youth With Diabetes Mellitus
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Self-citation12. Children and Adolescents: Standards of Medical Care in Diabetes—2018
American Diabetes Association (2017) · Diabetes Care · doi:10.2337/dc18-s012 · Cited by 196 · see citing works
2018 Guidelines for the Management of Dyslipidemia in Korea
Rhee, E., Kim, H. C., Kim, J. H., Lee, E. Y., Kim, B. J., Kim, E. M., Song, Y., Lim, J. H., Kim, B. J., Choi, S., et al. (2019) · Journal of Lipid and Atherosclerosis · doi:10.12997/jla.2019.8.2.78 · Cited by 192 · see citing works
14. Children and Adolescents: Standards of Care in Diabetes—2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Echouffo-Tcheugui, J. B., Ekhlaspour, L., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s014 · Cited by 173 · see citing works
Daniels, S. R., Gidding, S. S., & de Ferranti, S. D. (2011) · Journal of clinical lipidology · doi:10.1016/j.jacl.2011.03.453 · Cited by 173 · see citing works
Self-citationCarotid Intima-Media Thickness in Children With Familial Hypercholesterolemia
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- Authors
- McCrindle, B. W., Urbina, E. M., Dennison, B. A., Jacobson, M. S., Steinberger, J., Rocchini, A. P., Hayman, L. L., & Daniels, S. R.
- Affiliations
- Hospital for Sick Children (CA)
- ORCID
- Venue
- Circulation
- Published
- 2007-04-10
- Volume
- 115
- Issue
- 14
- Pages
- 1948-1967
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2070344375
- Cited by
- 418
- References
- 153
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 5 · 2023: 5 · 2022: 5 · 2021: 8 · 2020: 19 · 2019: 11 · 2018: 7 · 2017: 12 · 2016: 18 · 2015: 23 · 2014: 26 · 2013: 32 · 2012: 36
- FWCI
- 53.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
- Keywords
- familial hypercholesterolemia, severe hypercholesterolemia, lipid-lowering therapy, statins, early atherosclerosis, children and adolescents, patient selection, treatment monitoring
- MeSH terms
- Contraindications, Adolescent, Adult, Age Factors, Anticholesteremic Agents, Hypolipidemic Agents, Arteriosclerosis, Child, Child, Preschool, Cholesterol, Dietary, Clinical Trials as Topic, Combined Modality Therapy, Dietary Fats, Exercise Therapy, Female, Humans, Hyperlipoproteinemia Type II, Hyperlipoproteinemias, Infant, Cholesterol, LDL, Male, Phytotherapy, Middle Aged, Obesity, Risk Factors, Ultrasonography, HIV Infections, HIV Protease Inhibitors, Age of Onset, Disease Progression, Diet, Fat-Restricted, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Metabolic Syndrome, Diabetes Complications, Dyslipidemias
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