Holmes Kathryn Wood, Kwiterovich Peter Oscar
Divisions of Pediatric Cardiology and Lipid Research Atherosclerosis, Johns Hopkins Medical Institutions, 550 North Broadway, Suite 312, Baltimore, MD 21205, USA.
Curr Cardiol Rep. 2005 Nov;7(6):445-56. doi: 10.1007/s11886-005-0063-x.
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.
动脉粥样硬化的早期病变始于儿童期，与先前存在的心血管疾病危险因素有关。饮食、肥胖、运动等环境和遗传因素以及某些遗传性血脂异常会影响此类病变的进展。识别有动脉粥样硬化风险的青少年需要对这些易感因素进行综合评估。治疗首先从摄入低总脂肪、饱和脂肪和胆固醇的饮食开始，使用水溶性纤维和植物甾醇，控制体重并进行锻炼。对于有早发性冠状动脉疾病家族史且低密度脂蛋白胆固醇高于160mg/dL的患者，在采取饮食和卫生措施后，可考虑药物治疗，例如使用羟甲基戊二酰辅酶A还原酶抑制剂、胆汁酸螯合剂和胆固醇吸收抑制剂。药物治疗的候选者通常包括家族性高胆固醇血症、家族性混合性高脂血症、代谢综合征、多囊卵巢综合征、I型糖尿病和肾病综合征患者。我们回顾了饮食和药物治疗的安全性和有效性，并提出了一种更新的诊断和治疗算法，其中包括代谢综合征。早期识别和治疗血脂异常的青少年可能会延缓动脉粥样硬化进程。
