Pediatric Dyslipidemia: A Practical Guide

Description:

Pediatric lipidology is a relatively new field of pediatrics. Premature cardiovascular diseases account for 30% of mortality in the United States. There is a heightened awareness regarding early recognition, prevention and management of childhood dyslipidemia.

This book fulfils the need for a concise, quick-reference guide on clinical approach to the management of pediatric lipid disorders. Rational and optimal medical practice approaches are outlined throughout the text. Current clinical guidelines for treatment of genetic and acquired pediatric dyslipidemias are reviewed with an emphasis on new data and novel therapeutic options. This book is aimed to guide clinical decisions and improve care of at-risk youth in the primary prevention of premature atherosclerotic cardiovascular disease.

Written by experts in the field, Pediatric Dyslipidemia includes the most up-to-date scientific and clinical information for pediatricians, endocrinologists, primary care practitioners and any other medical practitioners treating children with dyslipidemia.

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Preface

The vision behind this book, entitled Pediatric Dyslipidemia: A Practical Guide, was to create a comprehensive and easily accessible guide for quick referencing when lipid abnormalities are encountered in an office setting. The book is designed to include figures and tables with a clinical focus for accurate diagnosis and management of pediatric dyslipidemia. In addition, this book on pediatric dyslipidemia distinguishes itself by its concise nature, reader friendliness for trainees, practicing pediatricians, endocrinologists, and other subspecialists, emphasizing practical management strategies readily applicable in a busy clinical practice. Most of the chapters include clinical vignettes to discuss commonly encountered clinical scenarios. National and international leaders in pediatric lipidology contributed to the book, and we are grateful to the authors for their knowledge and invaluable contributions. We want to dedicate a special acknowledgment to children with dyslipidemia who taught us important lessons about primary prevention, risk mitigation, diagnosis, and management.

Table of contents :
Foreword
Preface
Contents
Contributors
Chapter 1: History and Significance of Pediatric Lipidology
Introduction
Lipid Lowering Medications
Conclusion
References
Chapter 2: An Overview of Lipid Metabolism
Introduction
Understanding Simple and Complex Lipids
Exogenous Pathway of Lipid Metabolism
Endogenous Pathway of Lipid Metabolism
Reverse Cholesterol Transport
LDL and Atherosclerosis
Conclusions
References
Chapter 3: Lipid Screening in for Pediatrics
Rationale for Screening
Lipid Screening Recommendations
Cascade Screening
Reference Ranges of Lipid Values by Age
Epidemiology
Conclusions
References
Chapter 4: Measurement of Lipids and Lipoproteins
Plasma Lipids
Standard Lipid Panel
Estimated LDL-C
Direct LDL-C Measurements
Special Considerations
Expanded Lipid/Lipoprotein Profile
Vertical Spin Density Gradient Ultracentrifugation
Nuclear Magnetic Resonance Spectroscopy (NMR)
Apolipoprotein B (apoB)
Lipoprotein (a)
Other Lipid-Related Assays
Apolipoprotein A1
NMR-Derived Marker Lipoprotein Insulin Resistance Index (LP-IR)
References
Chapter 5: Diagnosis and Management of Youth with Disorders of LDL Cholesterol
Introduction
Hypercholesterolemia
Overview
Diagnosis
Biochemical Testing
Genetic Testing
Imaging
Carotid Intima-Media Thickness (CIMT)
Pulse Wave Velocity (PWV)
Flow Mediated Dilation (FMD)
Echocardiograph
Advanced Imaging
Management
Hypocholesterolemia
Overview
Genetic Variants
Management
Conclusions
References
Chapter 6: Therapies for Lowering Low-Density Lipoprotein Cholesterol
Introduction
Non-pharmacological Management
Lifestyle Changes
Dietary Supplements
Pharmacological Management
When to Start Pharmacological Therapy
Pharmacologic Therapy Goals
HMG-CoA Reductase Inhibitors (Statins)
Bile Acid Sequestrants
Cholesterol Absorption Inhibitors (Ezetimibe)
PCSK9 Inhibitors
Fibrates
Niacin
Omega-3 Fish Oils
Treatment Modalities for Specific Conditions
Conclusion
References
Chapter 7: Combined Dyslipidemia
Combined Dyslipidemia
Definition
Pathophysiology
Prevalence
Atherogenicity
Making the Diagnosis of Combined Dyslipidemia
Management of Combined Dyslipidemia
Evidence for Response to Lifestyle Change
Conclusion
References
Chapter 8: Approach to Management of Combined Dyslipidemia
Introduction
Lifestyle Approaches to Obesity and Combined Dyslipidemia
Dietary Components with the Most Significant Impact on Dyslipidemia (Summarized in Table 8.1)
Fats
Cholesterol
Fiber
Dietary Patterns
Mediterranean Diet
DASH Eating Pattern
Weight Management
Special Considerations
Behavior Change
Socioeconomic Concerns
Management of Combined Dyslipidemia by Activity Enhancement
Medication Therapy for Combined Dyslipidemia
HMG-CoA Reductase Inhibitors (Statins)
Omega-3 Fish Oil
Peroxisome Proliferator-Activated Receptor Agonists (Fibrates)
Nicotinic Acid (Niacin)
Summary
References
Chapter 9: Approach to Hypertriglyceridemia
Definition of Hypertriglyceridemia
Pathophysiology
Genetics of Hypertriglyceridemia
Secondary Causes of Hypertriglyceridemia
Severe Monogenic Hypertriglyceridemia: Familial Chylomicronemia Syndrome
Other Monogenic Disorders Associated with Hypertriglyceridemia
Polygenic or Multifactorial Chylomicronemia
Combined Hyperlipidemia
Obesity-Associated Dyslipidemia
Approach to the Patient with HTG-Associated Pancreatitis (Table 9.4)
General Non-pharmacologic Approaches to HTG (Table 9.5)
Drug Treatment for Severe HTG (Table 9.6)
Fibric Acid Derivatives (Fibrates)
Omega-3 Fatty Acids
Other Available Therapies (Table 9.6)
Targeting Apolipoprotein C-III: Volanesorsen; olezarsen; AROAPOC3 (Table 9.7)
Targeting Angiopoietin-Like Protein 3: Evinacumab, vupanorsen, and AROANG3 (Table 9.7)
Summary
References
Chapter 10: Lipoprotein (a) [Lp(a)] Introduction
Structure and Metabolism of Lp(a)
LPA Gene
Function of Lp(a)
Laboratory Measurement of Lipoprotein(a)
Association of Lp(a) with Atherosclerotic Cardiovascular Disease
Lp(a) in Children
Interventions for Decreasing Lp(a)
Guidelines for Measuring Lp(a) in Adults
Guidelines for Measuring Lp(a) in Youth
Future Directions
Summary
References
Chapter 11: Rare Genetic Dyslipidemia
Introduction
Sitosterolemia
Lipodystrophy
Hypoalphalipoproteinemia
Tangier Disease
LCAT Deficiency
Apolipoprotein A-I Deficiency
Abeta and Hypobetalipoproteinemia
Cerebro-Tendinous Xanthomatosis
Lipoprotein X
Conclusions
References
Index