The Lipid Clinic at The Children’s Hospital

Identification and management of pediatric patients for the prevention of early onset coronary artery disease and stroke remains controversial. Routine screening with lipid profiles or total cholesterol levels in families without early onset coronary artery disease or stroke still is of debatable value. Some patients are identified with statistically high cholesterol or triglycerides, but without associated risk factors (hypertension, obesity, diabetes, inactivity, smoking, etc.), most of these patients are not treated pharmacologically. Therefore, the approach at The Children’s Hospital is to screen only children with high-risk families or adoptive children with unknown family histories.

The profile of patients who are being referred to the Lipid Clinic at The Children’s Hospital has changed drastically over the years. Instead treating those with familial high cholesterol, the most common group includes those with mild elevation in LDL and total cholesterol, but with significant elevation in triglycerides and a low HDL. These children are often pre-diabetic, are somewhat insulin-resistant, are ill-conditioned, and obese. The first line of management of these patients is one of lifestyle adjustment, with an emphasis on dietary and exercise modification and control of other risk factors, such as high blood pressure, smoking, and weight management.