PEDIATRIC HYPERLIPEDEMIA AND OBESITY

1. Paediatric Cardiology Case
Scenarios
Dr Murtaza Kamal

2. Scenario: A

3. • 12 years old child, student of class 7th
• Sedentary life: Online classes in COVID
period, TV addict, no outdoor game,
prefers fast and junk food
• BMI: 31 kg/m2
• No family h/o SCD, HT, DM
The scenario…

4. Overweight and obesity: Definition

5. How commonly do you encounter obesity in
your office practice?

6. Why should we spare the genetics?…

7. Genetics is not confined to syndromes only…
• Mutations in genes encoding proteins
regulating appetite + metabolism
• Leptin- melanocortin pathway: Hunger+
energy homeostasis-> Mutation—>
Hyperphagia+ obesity

8. Long term CV risk
• Direct relationship with SBP, DBP, TGs levels
and inverse relation with HDL
• Obesity related HT and metabolic syndrome:
– Insulin resistance
– Na retention
– Increased sympathetic nervous activity
– RAAS activation
– Altered vascular function

9. How do you tackle these obese children (in
terms of prevention+ treatment)?

10. Prevention+ management continued…
• Outdoor physical activities and games
• Good healthy eating habits:
• Avoidance of junk/ fast foods
• Colour the food plate

11. How commonly have you prescribed drugs for
obesity management in your patients?
• Sibutramine (Reduces food intake +
attenuates the fall in metabolic rate)
• Orlistat (Reversible inhibitor of gastric and
pancreatic lipase)
• Setmelanotide (Melanocortin 4 receptor
agonist)

12. Scenario: B

13. The scenario…
• 14 years old young active boy
• BMI: 26.5Kg/m2, BP: 116/76 mm hg
• Family h/o: Grandfather died at an age of
49 years
• Lipid profile: Cholesterol: 240mg/dl, LDL:
180 mg/dl, HDL: 32 mg/dl, TGs: 172mg/dl

14. Future risk of CV morbidity
• Process of atherosclerosis begins in 1st decade
• Increase in cholesterol+ apolipoprotein levels in
childhood:
• Increase in cIMT
• Reduction in carotid elasticity
• Compromised brachial endothelial function
• Severity: Number+ intensity of risk factors
• Most powerful tool: Early detection of CV risk
in childhood

15. Future risk of CV morbidity
• LDL-C: Most implicated
• Continuous exposure to high serum LDL-C during
adolescence
• -> Accumulation of calcium in coronary
arteries
• -> Development of atherosclerotic
plaques
• Hypercholesterolemia: Most relevant CV risk
factor linked to progression of CAD

16. How often do you come across children with
hyperlipidemia in your office?
Limited information
Jaipur: 237 school children(13–17 years)
Borderline hypercholesterolemia (170–199 mg/dl): 33%
Definite hypercholesterolemia: 6.8%
Gupta et al. 1236 adolescents and young adults: Males & females respectively:
High total cholesterol 14% and 15%
High LDL cholesterol 12% and 13%
High triglycerides 14% and 16%
Low HDL cholesterol in 5%

17. How much to target for then?

18. When & whom to screen?
• AAP: Serum levels of cholesterol (total, LDL-C
and HDL-C)+ TGs in all children at 10 + 19 years
• Non-invasive methods for risk stratification:
cIMT+ LV morphology, to prevent future
development of CVD

19. How do you tackle these children (in terms of
prevention+ treatment)?
• Diagnose hypercholesterolemia and start
early targeted treatment
• First line:
• Behavioural intervention
• Lifestyle modification
• Eating habits

20. How frequently do you prescribe statins to
these children?
• Safe in children and adolescents
• Treatment with low doses indicated in
children with heterozygous form of FH from
8-10 years
• —> Long term benefit
• —> Lower incidence of
atherosclerotic CVD in 40 years
follow up

21. CV risk in children: A burden for future generations