Myopathy in Statin-Treated Children and Adolescents: A Practical Approach.

Purpose Of Review: This paper reviews the existing literature on statin-related myopathy in children and adolescents, to inform development of a practical management approach.

Recent Findings: Reports of statin treatment in the pediatric population revealed no evidence of muscle pathology, with asymptomatic elevation of creatine kinase(CK) levels and symptoms of muscle pain without CK elevation seen equally in subjects and controls in RCTs. By contrast, rare cases of rhabdomyolysis have now been documented in statin-treated children; this serious problem had never been previously reported.

Combined Dyslipidemia in Children and Adolescents: a Proposed New Management Approach.

Purpose Of Review: Combined dyslipidemia (CD), the predominant abnormal lipid pattern in children and adolescents, is characterized by moderate/severe triglyceride elevation with reduced high-density lipoprotein cholesterol. CD is prevalent, present in 30-50% of obese adolescents. Epidemiologic and lipid sub-population findings demonstrate CD to be highly atherogenic.

Effectiveness and Safety of Statin Therapy in Children: A Real-World Clinical Practice Experience.

Background: Statin use for hypercholesterolemia in children is predominantly reported from short-term clinical trials. In this study, we assess the efficacy and safety of statin treatment in clinical pediatric practice.

Methods: Records of all patients who began statin treatment at age <18 years and remained on statins for >6 months from 5 pediatric lipid clinics were reviewed.

Incorporating Risk Stratification Into the Practice of Pediatric Preventive Cardiology.

Atherosclerosis in its earliest stages is associated with the same traditional cardiovascular disease (CVD) risk factors as are associated with manifest CVD events in adulthood. Clustering of risk factors is associated with exponential increases in atherosclerotic burden from a young age. Some medical conditions and risk behaviours occurring in children can either increase the likelihood of higher levels of risk factors (such as chronic kidney disease) or the presence of risk factor clustering (such as obesity and cardiometabolic syndrome) or are associated with acquired coronary artery pathology (such as Kawasaki disease).

Public Policy to Promote Healthy Cardiovascular Lifestyles in Children.

Health policy is an important component of prevention of cardiovascular disease (CVD) and promotion of health in childhood and adolescence, when major health behaviours are formed. Development of CVD-related health policy begins with continuous systematic collection, analysis, and interpretation of health-related data to establish the baseline prevalence of CV risk factors and behaviours. These findings allow identification of problems, initiation of focused research, and development of evidence-based interventions.

Combined dyslipidemia in childhood.

Combined dyslipidemia (CD) is now the predominant dyslipidemic pattern in childhood, characterized by moderate-to-severe elevation in triglycerides and non-high-density lipoprotein cholesterol (non-HDL-C), minimal elevation in low-density lipoprotein cholesterol (LDL-C), and reduced HDL-C. Nuclear magnetic resonance spectroscopy shows that the CD pattern is represented at the lipid subpopulation level as an increase in small, dense LDL and in overall LDL particle number plus a reduction in total HDL-C and large HDL particles, a highly atherogenic pattern. In youth, CD occurs almost exclusively with obesity and is highly prevalent, seen in more than 40% of obese adolescents.

Distinguishing cardiac syncope from vasovagal syncope in a referral population.

Objective: To identify characteristics that distinguish cardiac from vasovagal syncope.

Study Design: We compared characteristics of patients ≤18 years of age with vasovagal and cardiac syncope. Vasovagal syncope subjects represented all patients presenting to outpatient cardiology during a 1-year period for initial evaluation of syncope diagnosed with vasovagal syncope.

Left ventricular hypertrophy in hypertensive children and adolescents: predictors and prevalence.

Left ventricular hypertrophy is an independent predictor of cardiovascular morbidity and mortality in adults. In children, the primary correlate of left ventricular mass (LVM) is lean body mass, but fat mass, gender and systolic blood pressure are also contributors. LVM can be estimated from echocardiographic measurements, and by indexing this allometrically to height to the 2.

Developing the 2011 Integrated Pediatric Guidelines for Cardiovascular Risk Reduction.

This article reviews aspects of development of the recently released "Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents" for pediatric care providers that remain in the area of human judgment. Discussed will be the context in which the guidelines were developed, the formal evidence review process, a consideration of how quality grades were established, key social/ethical issues that the panel confronted, and a critique of the final work with recommendations for future guideline development. Lessons learned are that both a formal evidence review process is essential to developing a credible document, and human judgment is critical to producing a meaningful result.

Dyslipidemia and pediatric obesity.

Cardiovascular disease is the leading cause of death in the United States despite a reduction in mortality over the past 4 decades. Much of this success is attributed to public health efforts and more aggressive treatment of clinical disease. The rising rates of obesity and diabetes, especially among adolescents and young adults, raise concern for increases in mortality.

Surgical strategy for aortic coarctation repair resulting in physiologic arm and leg blood pressures.

Objective: The goal of aortic coarctation repair is laminar aortic blood flow resulting in a negative or absent arm:leg blood pressure (BP) gradient. Despite satisfactory relief of coarctation, associated arch hypoplasia can result in residual obstruction and postoperative upper body hypertension.

Intervention: We devised a surgical strategy to create a tension-free anastomosis with a diameter as large as both the adjacent proximal and distal aorta using a radically extended end-to-end anastomosis via sternotomy and/or thoracotomy.

Management of high blood pressure in children and adolescents.

Hypertension in childhood is now recognized to be a common and serious problem with a prevalence of 2% to 5%. Large epidemiologic studies have established normative tables for blood pressure beginning in early childhood based on age, gender, and height. Making a diagnosis of hypertension in a child or adolescent identifies an individual at increased risk for early-onset cardiovascular disease who requires specific treatment.

Prevalence and incidence of hypertension in adolescent girls.

Objective: To estimate the prevalence and incidence of hypertension and prehypertension and associated factors in adolescent girls.

Study Design: A total of 2368 girls (49% Caucasian, 51% African-American) aged 9 or 10 years enrolled in the National Heart, Lung, and Blood Institute Growth and Health Study had blood pressure, height, and weight measured at annual visits through age 18 to 19 years. Prevalence and incidence of hypertension and prehypertension were calculated.