Familial hypercholesterolemia in children and the importance of early treatment

Figures

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  Box 1. no caption available

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  FIGURE 1. Schematic illustration of cumulative LDL-C exposure in three patients. (a) A patient with FH who is not treated with lipid-lowering therapy. Cumulative LDL-C exposure increases with age and significantly surpasses the 160 mmol threshold for the onset of ASCVD. (b) A patient with FH who has been treated with LLT since adulthood. At the time of therapy initiation, the patient already had a substantial exposure to LDL-C. After initiating LLT the increase in LDL-C exposure is mitigated. (c) A patient with FH who has been optimally treated with LLT since childhood. The cumulative LDL-C exposure is clearly less elevated compared to patients A and B. LDL-C, LDL cholesterol; LLT, lipid-lowering therapy.

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  FIGURE 2. Kaplan-Meier curves for patients with familial hypercholesterolemia who began receiving statin therapy during childhood and their affected parents for whom statins were available much later in life. These results support the aforementioned statements emphasizing the critical importance of early detection and treatment. Adapted from [12]. FH, heterozygous familial hypercholesterolemia.

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  FIGURE 3. (a) Overview of conventional and novel treatment options for children with heterozygous familial hypercholesterolemia. 1Subcutaneous injection. 2Based on weight 3phase II trial 4phase III trial. PSCK9-i, proprotein convertase subtilisin/kexin type 9 inhibitor; siRNA, small interfering ribonucleic acid. (b) Overview of conventional and novel treatment options for children with homozygous FH ANGPTL-3, angiopoietin-like 3; PSCK9-i, proprotein convertase subtilisin/kexin type 9 inhibitor; siRNA, small interfering ribonucleic acid. 1Subcutaneous injection. 2Based on weight/age. 3Phase III trial.

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  FIGURE 4. Less progression of carotid intima-media thickness in children with heterozygous familial hypercholesterolemia versus their unaffected siblings after 2 years treatment with rosuvastatin from Braamskamp et al.[19].