Ann Pediatr Endocrinol Metab.  2020 Dec;25(4):199-207. 10.6065/apem.2040198.099.

2017 Clinical practice guidelines for dyslipidemia of Korean children and adolescents

• Lim JS
• Kim EY
• Kim JH
• Yoo JH
• Yi KH
• Chae HW
• Choi JH
• Kim JY
• Hwang IT
• the Committee of Dyslipidemia of Korean Children and Adolescents on behalf of Korean Society of Pediatric Endocrinology (KSPE)

• KMID: 2510890
• DOI: http://doi.org/10.6065/apem.2040198.099

Abstract

The Committee on Dyslipidemia of Korean Pediatric and Adolescents of the Korean Society of Pediatric Endocrinology has newly developed evidence-based clinical practice guidelines for dyslipidemia in Korean children and adolescents. These guidelines were formulated with the Grading of Recommendations, which include both the strength of recommendations and the quality of evidence. In the absence of sufficient evidence, conclusions were based on expert opinion. These guidelines are based on the 2011 National Heart, Lung, and Blood Institute Guidelines, which focus on the prevention of cardiovascular disease in children and draw from a comprehensive review of evidence. These guidelines contain the definition of and screening process for dyslipidemia and introduce new dietary methods: the Cardiovascular Health Integrated Lifestyle Diet (CHILD)-1, the CHILD-2-low-density lipoprotein cholesterol, and the CHILD-2-triglyceride. Potential drug therapies for dyslipidemia along with their main effects and doses were also included.

Keyword

Practice guidelines; Dyslipidemia; Child; Adolescent; Korea

Figure

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  Fig. 1. Algorithm for dyslipidemia treatment. FLP, fasting lipid profile; LDL-C, low-density lipoprotein cholesterol; CHILD 1, Cardiovascular Health Integrated Lifestyle Diet 1; CHILD 2-LDL, Cardiovascular Health Integrated Lifestyle Diet 2; non-HDL-C, non–high-density lipoprotein cholesterol; TG, triglycerides; CVD, cardiovascular disease.

Reference

References

1. The Global Burden of Disease 2004 Update [Internet]. Geneva (Switzerland): World Health Organization;2008. [cited 2020 May 3]. Available from: https://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf.

2. Korea National Statistical Office. Annual report on the cause of death statistics, 2010 [Internet]. Daejeon (Korea): Statistics Korea;[cited 2020 May 3]. Available from: http://kostat.go.kr/portal/eng/index.action.

3. Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med. 1998; 338:1650–6.

4. Stamler J, Daviglus ML, Garside DB, Dyer AR, Greenland P, Neaton JD. Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity. JAMA. 2000; 284:311–8.

5. Sone H, Tanaka S, Tanaka S, Iimuro S, Oida K, Yamasaki Y, et al. Serum level of triglycerides is a potent risk factor comparable to LDL cholesterol for coronary heart disease in Japanese patients with type 2 diabetes: subanalysis of the Japan Diabetes Complications Study (JDCS). J Clin Endocrinol Metab. 2011; 96:3448–56.

6. Goldbourt U, Yaari S, Medalie JH. Isolated low HDL cholesterol as a risk factor for coronary heart disease mortality. A 21-year follow-up of 8000 men. Arterioscler Thromb Vasc Biol. 1997; 17:107–13.

7. Jee SH, Jang Y, Oh DJ, Oh BH, Lee SH, Park SW, et al. A coronary heart disease prediction model: the Korean Heart Study. BMJ Open. 2014; 4:e005025.

8. McGill HC Jr, McMahan CA, Zieske AW, Tracy RE, Malcom GT, Strong JP. Effects of nonlipid risk factors on atherosclerosis in youth with a favorable lipoprotein profile. Circulation. 2001; 103:1546–50.

9. Ko M, Kim MT, Nam JJ. Assessing risk factors of coronary heart disease and its risk prediction among Korean adults: the 2001 Korea National Health and Nutrition Examination Survey. Int J Cardiol. 2006; 110:184–90.

10. Kim S, Moon S, Popkin BM. The nutrition transition in South Korea. Am J Clin Nutr. 2000; 71:44–53.

11. Lauer RM, Lee J, Clarke WR. Factors affecting the relationship between childhood and adult cholesterol levels: the Muscatine Study. Pediatrics. 1988; 82:309–18.

12. Kavey RE, Daniels SR, Lauer RM, Atkins DL, Hayman LL, Taubert K, et al. American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood. Circulation. 2003; 107:1562–6.

13. Raitakari OT, Juonala M, Kahonen M, Taittonen L, Laitinen T, Maki-Torkko N, et al. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA. 2003; 290:2277–83.

14. McGill HC Jr, McMahan CA, Malcom GT, Oalmann MC, Strong JP. Effects of serum lipoproteins and smoking on atherosclerosis in young men and women. The PDAY Research Group. Pathobiological Determinants of Atherosclerosis in Youth. Atheroscler Thromb Vasc Biol. 1997; 17:95–106.

15. Kim SH, Ahn BC, Joung H, Park MJ. Lipid profiles and prevalence of dyslipidemia in Korean adolescents. Endocrinol Metab. 2012; 27:208–16.

16. Yang S, Hwang JS, Park HK, Lee HS, Kim HS, Kim EY, et al. Serum lipid concentrations, prevalence of dyslipidemia, and percentage eligible for pharmacological treatment of Korean children and adolescents; data from the Korea National Health and Nutrition Examination Survey IV (2007-2009). PLoS One. 2012; 7:e49253.

17. Hickman TB, Briefel RR, Carroll MD, Rifkind BM, Cleeman JI, Maurer KR, et al. Distributions and trends of serum lipid levels among United States children and adolescents ages 4–19 years: data from the Third National Health and Nutrition Examination Survey. Prev Med. 1998; 27:879–90.

18. Ford ES, Li C, Zhao G, Mokdad AH. Concentrations of low-density lipoprotein cholesterol and total cholesterol among children and adolescents in the United States. Circulation. 2009; 119:1108–15.

19. Shim YS, Baek JW, Kang MJ, Oh YJ, Yang S, Hwang IT. R eference values for the triglyceride to high-density lipoprotein cholesterol ratio and non-high-density lipoprotein cholesterol in Korean Children and Adolescents: the Korean National Health and Nutrition Examination Surveys 2007-2013. J Atheroscler Thromb. 2016; 23:1334–44.

20. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011; 128(Suppl 5):S213–56.

21. Havel PJ. Dietary fructose: implications for dysregulation of energy homeostasis and lipid/carbohydrate metabolism. Nutr Rev. 2005; 63:133–57.

22. Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, Franch HA, et al. Summary of American Heart Association Diet and Lifestyle Recommendation revision 2006. Arterioscler Thromb Vasc Biol. 2006; 26:2186–91.

23. US Preventive Services Task Force. Screening for lipid disorders in children: US Preventive Services Task Force recommendation statement. Pediatrics. 2007; 120:e215–9.

24. Haney EM, Huffman LH, Bougatsos C, Freeman M, Fu R, Steiner RD, et al. Screening for lipid disorders in children and adolescents [Internet]. Rockville: Agency for Healthcare Research and Quality;2007. [cited 2020 May 3]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK33480/.

25. Slack J. Risks of ischaemic heart-disease in familial hyperlipoproteinaemic states. Lancet. 1969; 2:1380–2.

26. Srinivasan SR, Frontini MG, Xu J, Berenson GS. Utility of childhood non-high-density lipoprotein cholesterol levels in predicting adult dyslipidemia and other cardiovascular risks: the Bogalusa Heart Study. Pediatrics. 2006; 118:201–6.

27. Cu i Y, Blu ment ha l R S, Fl aw s JA, Whiteman M K, Langenberg P, Bachorik PS, Bush TL. Non-high-density lipoprotein cholesterol level as a predictor of cardiovascular disease mortality. Arch Intern Med. 2001; 161:1413–9.

28. Frontini MG, Srinivasan SR, Xu JH, Tang R, Bond MG, Berenson G. Utility of non-high-density lipoprotein cho¬lesterol versus other lipoprotein measures in detecting subclinical atherosclerosis in young adults (The Bogalusa Heart Study). Am J Cardiol. 2007; 100:64–8.

29. Hong HR, Kim SU, Kang HS. Physical activity and metabolic syndrome in Korean children. Int J Sports Med. 2009; 30:677–83.

30. Shin KO, Oh SY, Park HS. Empirically derived major dietary patterns and their associations with overweight in Korean preschool children. Br J Nutr. 2007; 98:416–21.

31. US department of agriculture; US Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th ed. Washington, DC: US Government Printing Office;2011.

32. Becque MD, Katch VL, Rocchini AP, Marks CR, Moorehead C. Coronary risk incidence of obese adolescents: reduction by exercise plus diet intervention. Pediatrics. 1988; 81:605–12.

33. McCrindle BW; American Heart Association Writing Group, Urbina EM, Dennison BA, Jacobson MS, Steinberger J, et al. Summary of the American Heart Association's scientific statement on drug therapy of high-risk lipid abnormalities in children and adolescents. Arterioscler Thromb Vasc Biol. 2007; 27:982–5.

34. McCrindle BW, Urbina EM, Dennison BA, Jacobson MS, Steinberger J, Rocchini AP, et al. Drug therapy of highrisk lipid abnormalities in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, with the Council on Cardiovascular Nursing. Circulation. 2007; 115:1948–67.

35. Daniels SR. Pediatric guidelines for dyslipidemia. J Clin Lipidol. 2015; 9(5 Suppl):S5–10.

36. Manlhiot C, Larsson P, Gurofsky RC, Smith RW, Fillingham C, Clarizia NA, et al. Spectrum and management of hypertriglyceridemia among children in clinical practice. Pediatrics. 2009; 123:458–65.

37. Berglund L, Brunzell JD, Goldberg AC, Goldberg IJ, Sacks F, Murad MH, et al. Evaluation and treatment of hypertriglyceridemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012; 97:2969–89.

38. Wiegman A, Hutten BA, de Groot E, Rodenburg J, Bakker HD, Buller HR, et al. Efficacy and safety of statin therapy in children with familial hypercholesterolemia: a randomized controlled trial. JAMA. 2004; 292:331–7.

39. McCrindle BW, Ose L, Marais AD. Efficacy and safety of atorvastatin in children and adolescents with familial hypercholesterolemia or severe hyperlipidemia: a multicenter, randomized, placebo-controlled trial. J Pediatr. 2003; 143:74–80.

40. de Jongh S, Ose L, Szamosi T, Gagne C, Lambert M, Scott R, et al. Efficacy and safety of statin therapy in children with familial hypercholesterolemia: a randomized, doubleblind, placebo-controlled trial with simvastatin. Circulation. 2002; 106:2231–7.

41. Avis HJ, Vissers MN, Stein EA, Wijburg FA, Trip MD, Kastelein JJ, et al. A systematic review and metaanalysis of statin therapy in children with familial hypercholesterolemia. Arterioscler Thromb Vasc Biol. 2007; 27:1803–10.

42. Tonstad S, Knudtzon J, Sivertsen M, Refsum H, Ose L. Efficacy and safety of cholestyramine therapy in peripubertal and prepubertal children with familial hypercholesterolemia. J Pediatr. 1996; 129:42–9.

43. Blagden MD, Chipperfield R. Efficacy and safety of ezetimibe co-administered with atorvastatin in untreated patients with primar y hypercholesterolaemia and 044106coronary heart disease. Curr Med Res Opin. 2007; 23:767–75.