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Check the Lipid Profile? Why?

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1.To state the recommendations to obtain lipid profiles in children and adolescents ... profile after 6 months of regular menses or the use of an oral contraceptive ... – PowerPoint PPT presentation

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Title: Check the Lipid Profile? Why?


1
Check the Lipid Profile? Why?
  • Douglas W. Teske, MD
  • The Heart Center
  • Nationwide Childrens Hospital

2
Objectives
  • 1.To state the recommendations to obtain lipid
    profiles in children and adolescents
  • 2.To discuss the approach to an abnormal lipid
    profile
  • 3.To determine when to initiate a lipid lowering
    medication

3
Heart Healthy Lifestyle
  • Normal weight for height
  • Appropriate diet for level of physical activity
  • Daily exercise
  • No smoking or use of other tobacco products

4
Epidemic of Childhood Obesity
  • Concerns
  • - type 2 diabetes mellitus
  • - systemic hypertension
  • - risk of CVD in young adults
  • - cigarette smoking/use of OTPs
  • - oral contraceptives

5
Body Mass Index
  • BMI Obesity
  • (kg/M2) Classification
  • Underweight lt18.5
  • Normal 18.5-24.9
  • Overweight 25.0-29.9
  • Obesity 30.0-34.9 I
  • 35.0-39.9 II
  • Extreme obesity gt40.0 III

6
Metabolic Syndrome in Adults
  • Waist circumference men gt102 cm/gt40 in
  • female gt88 cm/gt35
    in
  • Triglyceride gt150 mg/dL
  • HDL-C men lt40 mg/dL
  • female lt50 mg/dL
  • Blood pressure gt130/gt85 mmHg
  • Fasting blood sugar gt100 mg/dL

7
Metabolic Syndrome in Pediatrics
  • No accepted definition
  • Concerns with increases in obesity, prediabetes
    mellitus, and type 2 diabetes mellitus
  • Concerns with autopsy findings of fatty streaks
    and fibrous plaques in adolescents
  • Treatment lower the BMI with lifestyle changes
    in diet and physical activity

8
Concern for the Present and Future
  • Increasing number of obese children and
    adolescents
  • Increasing number of inactive children and
    adolescents
  • Inability to significantly lower the number of
    children and adolescents who smoke and use other
    tobacco products

9
Childhood Risk Factors for Adult CVD
  • Obesity
  • Sedentary lifestyle
  • Cigarette smoking/use of OTPs
  • Hypertension
  • Hyperlipidemia
  • high LDL-C
  • low HDL-C

10
Lipid Screening
  • American Academy of Pediatrics
  • First screening after 2 y/o but no later than 10
    y/o
  • Should be a fasting lipid profile
  • Obtained in context of a well-child and health
    maintenance visit
  • If normal range valves, retest in 3 to 5 years

11
AAP Universal Screening Approach
  • First time recommendation for universal screening
    for pediatric patients
  • No data to support that a specific level of a
    childhood cholesterol will predict the risk of
    adult CVD
  • No data on lack of identification and treatment
    of children with a high lipid level will lead to
    an increased risk of CVD development

12
Universal Pediatric Approach
  • A family problem which requires changes in the
    behavior of the whole family
  • Improve the diet
  • Increase daily activities
  • Improve family lifestyle
  • Improve the school lunch
  • Join community activities
  • Stop family use of tobacco products

13
Healthful Eating Behaviors
  • Eat meals and snacks at regular times
  • Avoid calorie-dense snacks
  • At the dinner table, focus on conversation and
    not just the food
  • Plate the food
  • Dont eat in front of the TV
  • Eat slowly
  • Eat a healthy breakfast
  • Limit fast-food meals to once a week

14
Personal Recommendations
  • Ages 2 to 8/10 years old
  • heart healthy lifestyle recommendations
  • be aggressive in patients with diabetes, renal
    disease, congenital or acquired heart disease,
    collagen vascular disease, cancer survivors
  • Ages 8 to 10 years old
  • fasting lipid profile
  • consider dietitian, exercise physiologist,
    psychologist

15
Personal Recommendations
  • Normal profile and no need for ensuing
    intervention
  • repeat the FLP when 16-18 years old
  • Abnormal profile and a need for intervention
  • repeat the FLP in 1-2 years
  • Again abnormal in males increase the
    intervention or consider a medication
  • Again abnormal in females increase the
    intervention and consider a medication after a
    repeat profile after 6 months of regular menses
    or the use of an oral contraceptive

16
Fasting Lipid Profile
  • Normal lipid levels the same for 2-18 y/o
  • Concentrations in mg/dL
  • TC LDL-C HDL-C TG
  • acceptable lt170 lt100 gt40 (M)
  • gt50 (F)
  • borderline 170-199 100-129
  • elevated gt200 gt130 gt110

17
Fasting Lipid Profile
  • Intention to treat if LDL-C level
  • gt130 mg/dL with diabetes
  • gt160 mg/dL with a positive family history
  • parent/grandparent with an early cardiac event
  • parent/grandparent with a TC gt240 mg/dL
  • unknown family history
  • gt190 mg/dL with a negative family history

18
Abnormal Lipid Profile
  • Evaluate for secondary causes
  • exogenous drugs or obesity
  • endocrine and metabolic hypothyroidism and
    diabetes
  • storage diseases
  • obstructive liver diseases
  • chronic renal disease

19
Screening Laboratory Studies
  • Liver
  • ALT, AST, CK, PT/INR
  • Kidney
  • BUN, Cr, UA
  • Thyroid
  • T-4 total, TSH
  • Heme
  • CBC with differential and platelets

20
Medication Discussion
  • Need for compliance with long-term medicine use
  • Understanding that there is no evidence that
    pharmacologic treatment at a younger age will
    decrease morbidity and mortality from a CV event
  • Understanding that there is no evidence that it
    is safe and cost effective to treat for decades
    individuals with an elevated cholesterol level
  • Concern with labeling adolescents with a
    disease
  • Treatment could exacerbate the prevalence of
    eating disorders

21
Pharmacotherapeutic Agents
  • Bile acid sequestrant
  • Cholestyramine
  • Niacin
  • Statins
  • Pravastatin, Lovastatin, Simvastatin,
    Atorvastatin
  • Cholesterol absorption inhibitor
  • Fibrate

22
Statin Therapy
  • Use the statin of your choice at 10 mg/day taken
    at bedtime
  • Add a morning multivitamin with vitamin K
  • Emphasize an adequate daily calcium intake
  • Repeat the FLP in 2 months and adjust the statin
    dose
  • With a stable statin dose, repeat the FLP every
    6-12 months with yearly liver studies

23
Case Study 1
  • Female Age 8 years
  • Wt 51.5 kg (gt97)
  • Ht 132 cm (50-75)
  • BMI 29.3 kg/M2
  • BP 112/72 mmHg
  • TG 281 mg/dL
  • TC 224 mg/dL
  • HDL-C 35 mg/dL
  • LDL-C 133 mg/dL

24
Case Study 2
  • Male 11 years old
  • Wt 51.2 kg (95)
  • Ht 142.5 cm (50)
  • BMI 25.2 kg/M2
  • BP 106/64 mmHg
  • TG 58 mg/dL
  • TC 208 mg/dL
  • HDL-C 56 mg/dL
  • LDL-C 141 mg/dL

25
Case Study 2
  • Male 11 years old 16 years old
  • Wt 51.2 kg (95) 56.8 kg (50)
  • Ht 142.5 cm (50) 168.2 cm (50)
  • BMI 25.2 kg/M2 20.1 kg/M2
  • BP 106/64 mmHg 116/70 mmHg
  • TG 58 mg/dL 44 mg/dL
  • TC 208 mg/dL 160 mg/dL
  • HDL-C 56 mg/dL 50 mg/dL
  • LDL-C 141 mg/dL 101 mg/dL

26
Case Study 3
  • Male 14 years old
  • Wt 99.4 kg (gt97)
  • Ht 165.6 (50)
  • BMI 36.2 kg/M2
  • BP 124/58 mmHg
  • TG 199 mg/dL
  • TC 228 mg/dL
  • HDL-C 33 mg/dL
  • LDL-C 155 mg/dL

27
Case Study 3
  • Male 14 years old 15 years old
  • Wt 99.4 kg (gt97)
  • Ht 165.6 cm (50)
  • BMI 36.2 kg/M2
  • BP 124/58 mmHg
  • TG 199 mg/dL 266 mg/dL
  • TC 228 mg/dL 230 mg/dL
  • HDL-C 33 mg/dL 33 mg/dL
  • LDL-C 155 mg/dL 144 mg/dL

28
Case Study 4
  • Male 11 years old
  • Wt 68.3 kg (gtgt97)
  • Ht 160 cm (gt97)
  • BMI 26.7 kg/M2
  • BP 136/86 mmHg
  • TG 366 mg/dL
  • TC 248 mg/dL
  • HDL-C 40 mg/dL
  • LDL-C 134 mg/dL

29
Case Study 4
  • Male 11 years old 17 years old
  • Wt 68.3 kg (gtgt97) 122.1 kg (gtgt97)
  • Ht 160 cm (gt97) 186.5 cm (gt95)
  • BMI 26.7 kg/M2 35.1 kg/M2
  • BP 136/86 mmHg 142/88 mmHg
  • TG 366 mg/dL 453 mg/dL
  • TC 248 mg/dL 270 mg/dL
  • HDL-C 40 mg/dL 38 mg/dL
  • LDL-C 134 mg/dL

30
Case Study 5
  • Male 15 years old
  • Wt 107.5 kg (gt97)
  • Ht 178.9 cm (90)
  • BMI 33.6 kg/M2
  • BP 142/94 mmHg
  • TG 312 mg/dL
  • TC 333 mg/dL
  • HDL-C 20 mg/dL
  • LDL-C 243 mg/dL

31
Case Study 5
  • Male 15 years old 16 years old
  • Wt 107.5 kg (gt97) 81.1 kg (90)
  • Ht 178.9 cm (90) 180.3 cm (90)
  • BMI 33.6 kg/M2 24.9 kg/M2
  • BP 142/94 mmHg 120/72 mmHg
  • TG 312 mg/dl 88 mg/dL
  • TC 333 mg/dL 290 mg/dL
  • HDL-C 20 mg/dL 39 mg/dL
  • LDL-C 243 mg/dL 233 mg/dL

32
Case Study 6
  • Male 13 years old
  • Wt 46.8 kg (25)
  • Ht 163.8 cm (25-50)
  • BMI 17.4 kg/M2
  • BP 96/64 mmHg
  • TG 105 mg/dL
  • TC 347 mg/dL
  • HDL-C 46 mg/dL
  • LDL-C 280 mg/dL

33
Case Study 6
  • Male 13 years old 15 years old
  • Wt 46.8 kg (25)
  • Ht 163.8 cm (25-50)
  • BMI 17.4 kg/M2
  • BP 96/64 mmHg
  • TG 105 mg/dL 48 mg/dL
  • TC 347 mg/dL 179 mg/dL
  • HDL-C 46 mg/dL 44 mg/dL
  • LDL-C 280 mg/dL 125 mg/dL

34
Case Study 7
  • Female 13 years old
  • Wt 58.6 kg (75)
  • Ht 159 cm (50)
  • BMI 23.2 kg/M2
  • BP 122/70 mmHg
  • TG 65 mg/dL
  • TC 274 mg/dL
  • HDL-C 39 mg/dL
  • LDL-C 222 mg/dL

35
Case Study 7
  • Female 13 years old 16 years old
  • Wt 58.6 kg (75) 60.4 kg (50-75)
  • Ht 159 cm (50) 160.5 cm (25-50)
  • BMI 23.2 kg/M2 23.4 kg/M2
  • BP 122/70 mmHg 104/64 mmHg
  • TG 65 mg/dL 83 mg/dL
  • TC 274 mg/dL 203 mg/dL
  • HDL-C 39 mg/dL 37 mg/dL
  • LDL-C 222 mg/dL 149 mg/dL

36
10 Ways to Help Children Develop Healthy Habits
  • 10. Be an advocate for healthier children
  • 9. Make a game of reading food labels
  • 8. Make dinnertime a family time
  • 7. Find new ways to celebrate good behavior
  • 6. Set specific goals and realistic limits
  • 5. Be supportive
  • 4. Customize physical activities
  • 3. Limit TV, video games, iPod time, and
    computer time
  • 2. Get the whole family involved
  • 1. Be a positive role model
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