Study sheds light on LDL-C trajectories in childhood, supports screening advice


By Megan Brooks

NEW YORK (Reuters Health) - New data from the International Childhood Cardiovascular Cohort (i3C) consortium shed light on trajectories of low-density lipoprotein cholesterol (LDL-C) in childhood and on the possible prevalence of heterozygous familial hypercholesterolemia (FH) at that age.

The analysis of more than 15,000 U.S. children suggests that average LDL-C levels increase from age 3 to 10 years, decrease from age 10 to 15 years, and then increase again to reach adult levels.

"The take-home from this study is that LDL-C levels peaked between ages 9 to 11 years, and were higher in children who were female or Black, or had a higher BMI," first author Dr. Yiyi Zhang, with Columbia University Irving Medical Center in New York, commented in email to Reuters Health.

"The observation that childhood LDL-C peaked around age 9 years with levels similar to those at age 18 years supports current recommendations for childhood lipid screening at age 9-11 years," Dr. Zhang said.

In a primary analysis, they considered an LDL-C level of at least 160 mg/dL on at least one occasion to be consistent with probable heterozygous familial hypercholesterolemia (FH), according to thresholds cited by the American Heart Association

Their data suggested that the occurrence of a single LDL-C measurement at that level during childhood is "relatively common," Dr. Zhang noted, at 2.8%, corresponding to a rate ratio of 1 in 36 children.

In a secondary analysis, using more stringent criteria, the research team found that less than 1% of children had an LDL-C level of 190 mg/dL or higher on at least one occasion (rate ratio 1 in 173).

The prevalence of persistently high LDL-C consistent with FH was 0.3% to 1.0%, depending on the definition used, according to the JAMA Pediatrics report.

"LDL-C is a major modifiable risk factor for cardiovascular disease, and high childhood LDL-C levels often track into adulthood and contribute to atherosclerosis later in life. Therefore, it is important to understand LDL-C levels during childhood to inform primordial prevention of high LDL-C and downstream atherosclerosis," Dr. Zhang told Reuters Health.

"These findings have the potential to guide childhood lipid screening and management guidelines," she added.

SOURCE: JAMA Pediatrics, online July 19, 2021.

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