In the United States, approximately 20% of children and teenagers have dyslipidemia, or abnormal levels of lipids such as cholesterol and triglycerides. According to Pinar Gumus Balikcioglu, MD, MHSc, pediatric endocrinologist, “Dyslipidemia, especially hyperlipidemia, is a major risk factor for cardiovascular disease. In fact, research shows that untreated dyslipidemia in childhood may contribute to the development of heart disease earlier in adulthood.” 

Dyslipidemia may include one or more of the following:

• High levels of low-density lipoprotein cholesterol (LDL-C)
• High levels of triglycerides
• Low levels of high-density lipoprotein cholesterol (HDL-C)

The Pediatric Lipid Disorders Clinic at Duke Children’s offers specialized expertise in care and research related to pediatric dyslipidemia. The multidisciplinary team includes a medical geneticist, pediatric cardiologist, apheresis services, and clinical dietitian who evaluate patients, diagnose the root causes for each patient’s dyslipidemia, and then collaborate with patients and their families to create individualized care plans for each child. 
In addition to providing clinical care, Gumus Balikcioglu and her colleagues are regional and national leaders in the study of hyperlipidemia and early cardiovascular disease risk factors, including pathogenesis and predictors of progression to insulin resistance, glucose intolerance, and diabetes in children. The team’s ultimate goal is to prevent every child from developing early cardiovascular disease caused by a lipid disorder.

Pediatricians and other primary care providers should follow the American Academy of Pediatrics recommendation and perform universal lipid screening for all children between the ages of 9 and 11 and again between 17 and 21. Selective screening should also be considered for children as young as age 2 who have risk factors such as a family history of early heart disease, or medical conditions, including obesity, diabetes, or high blood pressure.

• Inherited hypercholesterolemia (homozygous or heterozygous familial hypercholesterolemia)
• Inherited severe hypertriglyceridemia
• Obesity and insulin resistance
• Type 1 and Type 2 diabetes mellitus
• Hypothyroidism
• Kidney disease (nephrotic syndrome, renal failure)
• Obstructive liver disease
• Polycystic ovarian syndrome (PCOS)
• Cushing’s syndrome
• Inflammatory bowel disease (IBS)
• Lipodystrophy
• Everolimus treatment
• HIV infection

It’s ideal to refer pediatric patients to the Pediatric Lipid Disorders Clinic when: 

• LDL-C levels are ≥160 mg/dl with no other risk factors
• LDL-C levels are ≥130 mg/dl with one known risk factor for adverse cardiovascular events

Gumus Balikcioglu notes that risk factors for adverse cardiovascular events associated with high lipid levels (hyperlipidemia) are stratified based on the patient’s personal and family history. “The use of medications for hyperlipidemia in children is also based on this same stratification,” she says. 

She adds, “Overall risk stratification level is increased for patients who have at least two of the following in addition to the risk factors above: Family history of early cardiovascular disease, obesity, hypertension, smoking, or glucose intolerance.”