Assessment of atherosclerotic cardiovascular risk and management of dyslipidemia in obese children

摘要

As the prevalence of childhood obesity increases there is potential for an increase in prevalence and an earlier onset of coronary artery disease. Comorbidities of obesity such as dyslipidemia, insulin resistance syndrome, hypertension, sedentary lifestyle or associated lifestyle factors, like tobacco smoke exposure may result in premature onset of atherosclerosis. Obese children may have other diseases, which can also accelerate the development of atherosclerosis. As clinical atherosclerotic cardiovascular disease does not manifest in obese children, assessment of non-invasive markers of vessel function and structure may be helpful in further stratifying risk and in monitoring effects of intervention/Broad social and cultural changes outside the scope of the health sector are probably most effective in curtailing the epidemic of obesity and thus minimizing its cardiovascular manifestations. Pediatric health care providers should be diligent in screening and providing counseling regarding potential cardiovascular risk factors. Lifestyle alterations resulting in optimal weight management are of foremost importance in preventing the cardiovascular effects of obesity. A select group of children may be at high risk of premature cardiovascular disease despite rigorous implementation of these measures. These children may benefit from pharmacological therapy of dyslipidemia, insulin resistance syndrome or hypertension. Statins have been proven to be effective in decreasing blood low-density lipoprotein cholesterol levels in children and appear safe in the short-term, but their effect in eventually altering the timeline of atherosclerotic cardiovascular disease manifestations in adult life or its associated mortality and morbidity is unclear. The effect of risk factor modification on vascular functional and structural end points will continue to be a resource for evidence-based therapy in these children in the absence of hard clinical outcomes data. This article addresses an overview of assessment of atherosclerotic cardiovascular risk in obese children, but is restricted to an overview of the management of one risk factor -dyslipidemia.