The early lesions of
atherosclerosis begin in childhood, and are related to antecedent
cardiovascular disease risk factors. Environmental and genetic factors such as diet,
obesity, exercise, and certain inherited
dyslipidemias influence the progression of such lesions. The identification of youth at risk for
atherosclerosis includes an integrated assessment of these predisposing factors. Treatment starts with a diet low in total and saturated fat and
cholesterol, the use of water-soluble fiber and
plant sterols, weight control, and exercise.
Drug therapy, for example, with inhibitors of
hydroxymethylglutaryl CoA reductase,
bile acid sequestrants, and
cholesterol absorption inhibitors, can be considered in those with a positive family history of premature
coronary artery disease and a
low-density lipoprotein cholesterol above 160 mg/dL, after dietary and hygienic measures. Candidates for
drug therapy often include those with
familial hypercholesterolemia,
familial combined hyperlipidemia, the
metabolic syndrome,
polycystic ovarian syndrome, type I diabetes, and the
nephrotic syndrome. We review the safety and efficacy of dietary and
drug therapy, and propose an updated diagnostic and therapeutic algorithm that includes the
metabolic syndrome. The early identification and treatment of youth with
dyslipidemias is likely to retard the atherosclerotic process.