Management of dyslipidemia in children and adolescents with diabetes.

M any studies have demonstrated that the atherosclerotic process begins in childhood in association with high blood cholesterol levels (1–3). Lipid levels show a strong familial aggregation that has both a genetic and environmental component (4). Monogenic disorders including familial hypercholesterolemia and familial combined hyperlipidemia are expressed in childhood, although adverse diet, polygenic disorders, and environmental causes (including obesity) are the most common causes of high cholesterol levels in children. Adult patients with diabetes are at significant risk for cardiovascular disease (CVD). Because the combination of diabetes and dyslipidemia accelerates atherogenesis, aggressive lipid management is suggested for such patients (5). While the American Diabetes Association has stated lipid goals for adults with diabetes (6), no similar guidelines exist for children. To address this issue, a panel of experts in the areas of pediatric endocrinology, pediatric cardiology, and pediatric nephrology met on the 28th and 29th of July 2002 to hear presentations, review current lipid guidelines for children in general, and formulate a set of recommendations regarding the lipid management of children with diabetes. The panel was asked to develop a consensus position on the following questions: 1) Are there specific lipid abnormalities documented in children with diabetes? 2) Do lipid levels track from childhood to adulthood? 3) Does atherosclerosis begin in childhood? Is this related to dyslipidemia? 4) What is the frequency for monitoring lipid levels in children with diabetes? 5) How should elevated lipid levels be treated? 6) What additional research needs to be done in this area?