The early lesions of
atherosclerosis begin in childhood and are related to antecedent
cardiovascular disease (CVD) risk factors. Environmental and genetic factors (eg, diet,
obesity, exercise, and certain inherited
dyslipidemias) influence progression of such lesions. 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, use of water-soluble fiber, plant stanols 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 CVD and
low-density lipoprotein cholesterol >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 1 diabetes, and the
nephrotic syndrome. Such dietary and
drug therapy appears safe and efficacious. Early identification and treatment of youth with CVD risk factors and
dyslipidemia are likely to retard the atherosclerotic process. Optimal detection and treatment of high-risk children either from the general population or from families with premature CVD will require a comprehensive universal screening and evaluation program.