Hypercholesterolemic valvulopathy and severe atherosclerosis in paediatric patients

Background: Atherosclerosis is the leading cause of vascular disease worldwide, and traditionally it has been considered a disease of older individuals. However, this atherosclerotic process begins early in childhood, and when exposed to critically high levels of atherogenic risk factors, coronary artery disease may develop even during childhood. There are very few reports of coronary artery disease in young children, and most are linked to Kawasaki disease and congenital coronary abnormalities. Involvement of the mitral valve due to hypercholesterolaemia is rare and under-reported. Methods: We did a retrospective audit of all children (age <14 years) who underwent coronary angiogram between January 2005 and July 2024 in our tertiary care hospital. Only those children with atherosclerotic coronary artery disease were included. Results: We studied four paediatric cases of atherosclerotic coronary artery disease with concomitant valvular involvement despite ongoing lipid-lowering therapy. We highlight the mechanisms of valvular involvement and the challenges to the diagnosis and treatment of familial hypercholesterolaemia. Conclusions: These cases highlight the cardiovascular changes associated with this “malignant” atherosclerosis and emphasise the need for early recognition and prompt initiation of aggressive lipid-lowering therapy at diagnosis.