16
Cascade screening and reverse cascade screening are
recommended to enhance detection of individuals at risk for
FH.
B Moderate
An alternate treatment goal for pediatric FH patients in
whom it may not be possible to achieve an LDL-C level of
<130 mg/dL is a 50% reduction in LDL-C.
E Low
Diet and other lifestyle interventions, including increased
physical activity and weight management when overweight/
obesity is present, are recommended for lowering elevated
LDL-C, non-HDL-C, and TG in children and adolescents.
Dietary management strategies should be guided by a
registered dietitian nutritionist whenever feasible.
A High
Children ≥8 years of age are potential candidates for
pharmacologic treatment for lipid lowering.
e following treatment plans can be considered:
• Administer pharmacologic agents, primarily statins, when
LDL-C level is ≥190 mg/dL and/or non- HDL-C is
≥220 mg/dL.
• Consider additional risk factors in addition to elevated
LDL-C and/or non-HDL-C and follow the treatment
algorithm from the 2011 Expert Panel on Integrated
Guidelines for Cardiovascular Health and Risk Reduction in
Children and Adolescents: National Heart, Lung, and Blood
Institute.
B Moderate
Statins and bile acid sequestrants are pharmacologic agents
with evidence for efficacy and safety in children and
adolescents. ere is limited evidence on the safety and
efficacy of cholesterol absorption inhibitors in children and
adolescents.
B Moderate
Consideration should be given to measurement of
pretreatment fasting glucose or glycated hemoglobin levels,
liver enzymes, and creatine kinase in pediatric patients for
whom a statin is prescribed.
E Low
Potential side effects with lipid-altering pharmacotherapy
should be monitored in pediatric patients according to the
recommendations from the respective 2014 NLA statin safety
task force (http://www.lipidjournal.com/article/S1933-
2874(14)00159-7/pdf ).
B Moderate
Chart 5. Children and Adolescents (cont'd)
Recommendations
Strength Quality
Children and Adolescents
