Risk stratification and management for children with conditions predisposing to accelerated atherosclerosis and early cardiovascular disease

BMI: body mass index; BP: blood pressure; CVD: cardiovascular disease; FG: fasting glucose; FH: familial hypercholesterolemia; HCM: hypertrophic cardiomyopathy; HgbA1c: hemoglobin A1c; LDL-C: low-density lipoprotein cholesterol; NAFLD: nonalcoholic fatty liver disease; PCOS: polycystic ovary syndrome; TGA: transposition of the great arteries.

* Family history of premature CVD is generally defined as heart attack, treated angina, interventions for coronary artery disease, sudden cardiac death, or stroke in a first-degree relative (parent or sibling) before age 55 (males) or 65 (females).

¶ For children with type 1 or type 2 diabetes mellitus, lipid screening should be performed near the time of diagnosis but after glycemic control is well established, and then annually thereafter.

Δ For details of management of hypertension, dyslipidemia, and other specific conditions listed in this algorithm, refer to separate UpToDate content on these conditions in children.

◊ For patients with type 1 or type 2 diabetes mellitus who have elevated LDL-C in the setting of poor glycemic control, initiation of lipid-lowering therapy is usually deferred for 3 to 6 months in attempt to achieve better glycemic control, which may improve LDL-C levels. If hypercholesterolemia persists despite optimizing glycemic control, diet, and other risk factors, pharmacologic lipid-lowering therapy should be initiated.