Kwiterovich P O
Department of Pediatrics and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287-3654.
Atherosclerosis. 1994 Aug;108 Suppl:S55-71. doi: 10.1016/0021-9150(94)90153-8.
The early lesions of atherosclerosis in youth are strongly related to antemortem levels of total and low density lipoprotein (LDL) cholesterol, very low density lipoprotein (VLDL) cholesterol, and triglyceride, to ponderal index and to systolic and diastolic blood pressure. The major apolipoproteins of LDL and high density lipoprotein (HDL), apo B and apo A1, respectively, as well as levels of Lp(a) lipoprotein are often abnormal in children born to a parent with coronary artery disease (CAD). Other risk factors for CAD include obesity, high blood pressure, cigarette smoking, diabetes mellitus, positive family history of CAD and physical inactivity. Children from families with premature CAD, familial dyslipidemia or hypertension, and/or two other risk factors should have a lipoprotein profile determined. The first form of treatment is a diet low in total fat, saturated fat and cholesterol, combined with treatment of overnutrition and obesity, if necessary, and regular habits of aerobic physical activity. Children with inherited disorders of LDL metabolism may require the addition of lipid lowering therapy. The early detection and treatment of youth at risk for premature CAD offers the greatest promise to decrease morbidity and mortality.
青少年动脉粥样硬化的早期病变与生前总胆固醇、低密度脂蛋白（LDL）胆固醇、极低密度脂蛋白（VLDL）胆固醇和甘油三酯水平、体重指数以及收缩压和舒张压密切相关。父母患有冠状动脉疾病（CAD）的儿童，其LDL和高密度脂蛋白（HDL）的主要载脂蛋白，即分别为载脂蛋白B和载脂蛋白A1，以及Lp(a)脂蛋白水平通常异常。CAD的其他危险因素包括肥胖、高血压、吸烟、糖尿病、CAD家族史阳性以及缺乏体育活动。来自患有早发性CAD、家族性血脂异常或高血压和/或其他两个危险因素家庭的儿童，应进行脂蛋白谱检测。第一种治疗方式是低总脂肪、饱和脂肪和胆固醇饮食，必要时结合治疗营养过剩和肥胖，并养成定期进行有氧体育活动的习惯。患有遗传性LDL代谢紊乱的儿童可能需要加用降脂治疗。对有早发性CAD风险的青少年进行早期检测和治疗，最有希望降低发病率和死亡率。
