19
Figure 2. Dyslipidemia Algorithm Targeting LDL-C from the
2011 Expert Integrated Guidelines for Cardiovascular Health
and Risk Reduction in Children and Adolescents
TG ≥500 mg/dL,
→ Consult lipid specialist
Exclude secondary cause
Evaluate for other RFs
Start CHILD-1 →
CHILD-2-LDL (+ lifestyle
change x 6 mo
c
LDL-C ≥250 mg/dL,
→ Consult lipid specialist
FLP x 2
a
average
LDL-C ≥130, <250 mg/dL
b
→ Target LDL-C
TG ≥100, <500 mg/dL, <10 y → Target TG
TG ≥130, <500 mg/d, 10–19 y (see TG Supplement)
FLP
LDL-C <130 mg/dL,
→ Continue CHILD-2-LDL
→ Repeat FLP every 12 mo
LDL-C ≥130–189 mg/dL
FHX (-)
No other RFs
→ Continue CHILD-2-LDL
Follow every 6 mo with FLP
FHx/RF update
LDL-C ≥190 mgldL
→ lnitiate statin therapy
LDL-C ≥160–189 mg/dL
FHx (+) or
1 high-level RF or
≥2 moderate-level RFs
→ initiate statin therapy
LDL-C ≥130–159 mg/dL +
2 high-level RFs or
1 high-level RF +
≥2 moderate-level RFs
Or Clinical CVD
→ initiate statin therapy
Follow with FLPs, related chemistries
→ LDL-C still ≥130 mg/dL, TG <200 mg/dL, refer to lipid specialist for addition
of second lipid-lowering agent.
→ In high LDL-C patients, if non-HDL-C ≥145 mg/dL after effective LDL-C treatment,
→ Target TG (see Hypertriglyceridemia)
a
Obtain FLPs ≥2 weeks but ≤3 months
apart.
b
Per Table 8, use of drug therapy is
limited to children aged ≥10 years
with defined risk profiles.
c
In a child with an LDL cholesterol
level >190 mg/dL and other risk
factors, a trial of the CHILD-2-LDL
may be abbreviated.
