Fiorentino Riccardo, Chiarelli Francesco
Department of Paediatrics, University of Chieti, 66100 Chieti, Italy.
Biomedicines. 2021 Aug 24;9(9):1078. doi: 10.3390/biomedicines9091078.
Childhood dyslipidaemia is one of the main traditional cardiovascular risk factors that initiate and exacerbate the atherosclerotic process. Healthcare providers may play a key role in the management of children with lipid abnormalities; however, they have to properly evaluate the normal lipid values and know the available treatment options in children and adolescents. Current guidelines recommend healthy behaviours as the first-line treatment for childhood dyslipidaemia. The therapeutic lifestyle changes should focus on dietary modifications, daily physical activity, reduction in body weight and tobacco smoking cessation. Parents play a key role in promoting their children's healthy habits. In children with more severe forms of lipid abnormalities and in those who do not benefit from healthy behaviours, pharmacological therapy should be considered. Safe and effective medications are already available for children and adolescents. Statins represent the first-line pharmacological option, while ezetimibe and bile acid sequestrants are usually used as second-line drugs. Despite their limited use in children, other lipid-lowering agents (already approved for adults) are currently available or under study for certain categories of paediatric patients (e.g., familial hypercholesterolemia). Further studies are needed to evaluate the long-term efficacy, safety and tolerability of novel lipid-lowering drugs, especially in children.
儿童血脂异常是引发和加剧动脉粥样硬化进程的主要传统心血管危险因素之一。医疗保健提供者在管理血脂异常儿童方面可能发挥关键作用；然而，他们必须正确评估正常血脂值，并了解儿童和青少年可用的治疗选择。当前指南推荐健康行为作为儿童血脂异常的一线治疗方法。治疗性生活方式改变应侧重于饮食调整、日常体育活动、体重减轻和戒烟。父母在促进孩子养成健康习惯方面发挥关键作用。对于血脂异常更严重的儿童以及那些无法从健康行为中获益的儿童，应考虑药物治疗。目前已有安全有效的药物可供儿童和青少年使用。他汀类药物是一线药物选择，而依泽替米贝和胆汁酸螯合剂通常用作二线药物。尽管其他降脂药物在儿童中的使用有限（已获批用于成人），但目前某些类别儿科患者（如家族性高胆固醇血症）可用或正在研究这些药物。需要进一步研究以评估新型降脂药物的长期疗效、安全性和耐受性，尤其是在儿童中的情况。
