FH Video
How Concerned Are You About Familial Hypercholesterolemia In Your Practice?
Click here to view video!
Christie M. Ballantyne, MD
Director, Center for Cardiovascular Disease Prevention
Methodist DeBakey Heart Center
Codirector, Lipid Metabolism and Atherosclerosis Clinic
The Methodist Hospital
Associate Chief and Clinical Director
Section of Atherosclerosis, Department of Medicine
Director, Maria and Alando J. Ballantyne Atherosclerosis and Lipid Laboratory
Professor of Medicine and Pediatrics
Baylor College of Medicine
Houston, Texas
Familial Hypercholesterolemia (FH) is among the most common genetic lipid disorders; left untreated, FH patients have a 20-fold increased risk for CHD. As a consequence, males with FH often experience heart attacks in their thirties and forties, and women in their fifties. FH is a treatable disorder, but one of the great challenges is that FH remains underdiagnosed and undertreated.
To help combat this disease more effectively, the National Lipid Association Expert Panel on Familial Hypercholesterolemia has issued new recommendations for the diagnosis and management of FH. The panel included practitioners, cardiologists, and lipid specialists, and the goal of the recommendations is to work together to systematically screen, identify, and successfully manage patients with FH to reduce their risk of heart disease.
You can view this short video discussion by Christie M. Ballantyne, MD on the significance of the NLA recommendations.
I like video presentations, please provide more studying material on this way of presentation. Thankyou
Excellent. What statin would you give to a ten year old andwhat dose?
Dear DC,
First, I would like to state that here at Primary Issues, we offer no medical advice online. The information discussed here is provided to medical professionals for information purposes only. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested on this site should not be used by clinicians without evaluation of their patients’ conditions, review of any applicable manufacturers’ product information, and comparison with recommendations of recognized authorities.
With that being said, I did forward your email to one of our Medical Directors on the board and here is his response:
There are many reassuring studies on the safety and efficacy of statins in children with FH and four are FDA approved. Pravastatin is the only statin approved for FH for an 8-year-old at the single dose level of 20 mg, with 40 mg being its starting dose for a 10-year-old. Atorvastatin (starting dose of 10 mg), simvastatin (starting dose of 20 mg), and lovastatin (starting dose of 40 mg) are all approved at age 10 for FH. The choice of which statin should be individualized for each patient. Use the lowest dose to start. At base line and at four weeks, measure fasting lipoprotein profile, CK, ALT, and AST.
In a 10-year-old just as in an older patient, titrate the dose to the maximum recommended to reach the lipid goal as long as there are no toxicities. Continue to monitor with each change in dose and at least every three to six months. Also monitor growth and development (Tanner staging). For appropriate patients, counsel about the risk of drug interactions (such as cyclosporin and antifungals) and contraindications with pregnancy.
References:
1. McCrindle BW, Urbina EM, Dennison BA, et al. Drug therapy of high-risk 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(14):1948-1967.
doi: 10.1161/CIRCULATIONAHA.107.181946
2. Kwiterovich PO Jr. Recognition and management of dyslipidemia in children and adolescents. J Clin Endocrinol Metab. 2008;93(11):4200-4209.
3. Daniels SR, Greer FR; Committee on Nutrition. Lipid screening and cardiovascular health in childhood. Pediatrics. 2008;122(1):198-208.
very good
Excellent: Practical and important.
Is increased TG of 2200 cosidered genetis and how to treat it in a 50y/o samoin.thanks
Dear Batoor,
Samoan Islanders are known for their high incidence of hyperlipidemia and multiple genetic changes have been considered as the cause.[1] A genome-wide linkage scan identifies multiple chromosomal regions influencing serum lipid levels in the population on the Samoan islands.
Individual treatment recommendations are beyond the scope of our online information and educational services here at Primary Issues. If you would like to hear more about FH and get your specific questions answered by experts in person, please consider attending a live “Best Practices in Primary Care” program in Dearborn or Anaheim. You can sign up at http://www.primarycareed.com.
We can offer no medical advice online here at “Primary Issues.” The information discussed here is provided to medical professionals for information purposes only. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested on this site should not be used by clinicians without evaluation of their patients’ conditions, review of any applicable manufacturers’ product information, and comparison with recommendations of recognized authorities. Thank you for your comment.
[1] Aberg K, et al. A genome-wide linkage scan identifies multiple chromosomal regions influencing serum lipid levels in the population on the Samoan islands. J Lipid Res. 2008;49(10):2169-2178.
Good sound discussion.