Atherosclerosis and coronary artery disease begins early in life and is progressive throughout the life span(1-3). There is an important genetic component to the disease process that produces susceptibility(4). American Academy of Pediatrics (AAP) recommends screening for cholesterol in children as young as 2 years at high risk and aggressive use of cholesterol-lowering drugs as early as 8 years to lower the chances of heart problems later in life(5).

Based on the Western literature and a preliminary Indian study(6), we obtained lipid profile of high-risk children aged 2-10 years. High risk children had parents who had premature CAD (male parent or grandparents <55 years and female parent or grandparents <65 years), diabetes (fasting blood sugar >126mg% or random blood sugar >200mg% or who is on antidiabetic drugs), overweight (body mass index (BMI) of 23-29.9 kg/m2 or >85th percentile - <95th percentile), obesity (BMI >30kg/m2 or, >95th percentile) and high blood pressure (systolic blood pressure (SBP) >140 mmHg or diastolic blood pressure (DBP) >90mmHg or SBP and DBP >95th percentile) according to AAP guidelines.

A total of 150 children of high risk parents were requested to take part in our study of which 40 parents refused consent and 30 parents refused to provide blood sample of their children. This study was performed in 80 children and compared with age and sex matched normal children. Baseline characteristics were comparable in both groups. Average age of enrolled children was 5.9 years and 6.2 years in cases and control groups, respectively. Sex ratio was similar in both groups. Children were tested for total lipid profile after 12 hours of fasting and after ruling out secondary hypercholesterolemia. Difference between the two groups were compared and tabulated using unpaired student t test for continuous variable. P<0.05 was considered significant. Chi-square test was used to compare categorical variables. Results are as shown in Table I. Total serum cholesterol and LDL levels were significantly elevated in high risk children. However, HDL, TG and VLDL levels were not significantly different in two groups. No significant difference was observed in male and female children. Abnormally high cholesterol (>200mg%) and LDL (>130mg%) levels were present in 16 (20%) and 10 (12.5%), respectively in high risk children, and 2 (2.5%) and 1 (1.25%), respectively in control group (P<0.001).

Table I



Lipid Profile in High-risk Children (Mean ± SD)

Early diagnosis of hyperlipidemia and hypercholesterolemia is vital. It can encourage dietary and lifestyle modifications in children and adults. Screening for dyslipidemia should be done in high risk children so as to institute preventive measures as early as possible.