Family history and cardiovascular risk in familial hypercholesterolemia: data in more than 1000 children.
BACKGROUND
Elevated LDL cholesterol (LDL-C) levels in childhood predict cardiovascular disease (CVD) later in life. Familial hypercholesterolemia (FH) represents the paradigm of this relation.


RESULTS
The objectives of this study were to (1) establish the LDL-C level that provides the most accurate diagnosis of FH in children from families with known FH and (2) assess whether lipoprotein variation in these children is associated with premature CVD in relatives. Foremost, however, it was our objective to identify children with FH who are at high risk and in need of early intervention. A total of 1034 consecutive children from FH kindreds were investigated. First, LDL-C levels >3.50 mmol/L had a 0.98 post-test probability (95% CI, 0.96 to 0.99) of predicting the presence of an LDL receptor mutation. Second, children with FH in the highest LDL-C tertile (>6.23 mmol/L) had a 1.7-times higher incidence (95% CI, 1.24 to 2.36) of having a parent with FH suffering from premature CVD (P=0.001). In addition, such a parent was found 1.8 times more often (95% CI, 1.20 to 2.59) among children with FH who had HDL-C <1.00 mmol/L (P=0.004). Last, children with FH whose lipoprotein(a) was >300 mg/L had a 1.45-times higher incidence (95% CI, 0.99 to 2.13) of having a parent with FH suffering from premature CVD (P=0.05).


CONCLUSIONS
In FH families, LDL-C levels allow accurate diagnosis of FH in childhood. Moreover, increased LDL-C and lipoprotein(a) and decreased HDL-C levels in children identify FH kindreds with the highest CVD risk.
Wiegman
Albert
A
Department of Pediatrics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Rodenburg
Jessica
J
de Jongh
Saskia
S
Defesche
Joep C
JC
Bakker
Henk D
HD
Kastelein
John J P
JJ
Sijbrands
Eric J G
EJ
D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D018572:Disease-Free Survival; D005192:Family Health; D005260:Female; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D008019:Life Style; D008074:Lipoproteins / Q000097:blood; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D012372:ROC Curve; D012307:Risk Factors
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D008074:Lipoproteins; D008077:Lipoproteins, LDL