Current State of Pediatric Hyperlipidemia: Epidemiology, Management, and Emerging Therapies

Hyperlipidemia in children is an increasingly recognized public health concern. Both primary genetic disorders-notably familial hypercholesterolemia, which affects roughly 1 in 250 children-and secondary factors like obesity, diabetes, hypothyroidism, and nephrotic syndrome contribute to pediatric dyslipidemia. Unmanaged childhood hyperlipidemia can track into adulthood and drive premature atherosclerosis and cardiovascular disease. The American Academy of Pediatrics and National Heart, Lung, and Blood Institute recommend universal lipid screening at ages 9-11 years and again in late adolescence, with earlier targeted screening for high-risk children. Lifestyle modification is first-line therapy. When lifestyle measures are insufficient, pharmacologic treatment is considered from around 10 years of age for those with markedly elevated low-density lipoprotein or additional risk factors. Statins are the cornerstone, achieving 20-50% reductions in low-density lipoprotein levels with a favorable safety profile in children. Other agents, including ezetimibe, bile acid sequestrants, fibrates, omega-3 fish oils, and newer monoclonal antibodies to proprotein convertase subtilisin/kexin type 9, are used in select cases such as familial hypercholesterolemia or severe hypertriglyceridemia. Managing pediatric hyperlipidemia also entails overcoming challenges. Recent advances include the approval of proprotein convertase subtilisin/kexin type 9 inhibitors for pediatric use.