Dyslipidaemia
Dyslipidaemia (E78.9)
General and supportive measures
ICD-10 Code: E78.9
DESCRIPTION
| Phenotype | Elevated particles | Lipid increased |
Frequency |
| I | Chylomicron | TG | Rare |
| IIA | LDL | LDL-C | Common |
| IIB | LDL and VLDL | LDL-C, TG | Common |
| III | IDL | TC, TG | Rare |
| IV | VLDL | TG | Common |
| V | Chylomicron and VLDL | TG | Uncommon |
Dyslipidaemia is a broad term used to describe disorders of lipid metabolism that may be classified according to the Frederickson classification.
The three common types of dyslipidaemia are important because they are associated with an increased risk of cardiovascular disease due to atherosclerosis.
DIAGNOSTIC CRITERIA
Children with severe hypercholesterolaemia may present with xanthomas or myocardial infarction but most children with hypercholesterolaemia will be asymptomatic in childhood.
Children should be screened for dyslipidaemia if any of the following are present:
- Family history of premature cardiac disease or dyslipidaemia.
- Children should be screened from 8 years. Children should be screened earlier than 8 years if homozygous familial hypercholesterolaemia is suspected.
- A medical condition associated with dyslipidaemia: diabetes mellitus, nephrotic syndrome, liver disease, obesity.
INVESTIGATIONS
- Exclude causes of secondary hyperlipidaemia.
- In most cases, non-fasting total cholesterol is determined in children at risk. If the level is higher than the upper limit, a lipid profile is done after 12 hours of fasting.
- Upper limit of serum cholesterol and triglycerides: Total cholesterol 5.2 mmol/L.
- Triglycerides (after 12 hours of fasting):
- influenced by lifestyle – needs attention if > 1.68 mmol/L,
- pancreatitis risk if > 10 mmol/L.
GENERAL AND SUPPORTIVE MEASURES
Manage secondary causes of hyperlipidaemia according to guidelines. Schedule for integrated cardiovascular health promotion in children:
- Obesity
- Blood pressure
- With a family history of hypertension < 55 years of age: routine BP measurement from 3 years of age, once a year.
- If BP ≥ 95th percentile for sex, age, and height percentile, follow-up and investigate if persistently elevated.
- Diet
- Refer to a dietician.
- Learning healthy eating habits is an important preventative measure.
- Moderate salt intake.
- Physical activity
- Encourage active child-parent play.
- Limit child’s sedentary behaviour such as time watching television and playing video computer games to a maximum of 2 hours per day or 14 hours per week.
- Children should not be allowed to eat while watching television, i.e. no ‘grazing’.
- Organised sport 5 times per week for at least 20–30 minute periods.
- Smoking
- Encourage members of the household who smoke to stop.
MEDICINE TREATMENT
Consider medicine treatment only after failure of general and supportive measures to lower the cholesterol over 6–12 months.
Children should be at least 8 years of age for consideration of pharmacological intervention.
If LDL-C remains above 4.1 mmol/L in children with 2 or more risk factors, or above 4.9 mmol/L regardless of the presence of risk factors, refer to a paediatric specialist for consideration of statins:
Risk factors: smoking, hypertension, BMI ≥ 95th percentile (Z-score ≥ +1.96),
HDL-C < 1 mmol/L, diabetes mellitus, renal disease, male sex.
- Statins, e.g.:
- Simvastatin, oral, 10 mg at night.
Secondary hypercholesterolaemia due to nephrotic syndrome
See Chapter 6: Nephrological/Urological Disorders, section 6.3: Nephrotic syndrome.
REFERRAL
- Children with homozygous familial hypercholesterolaemia.
- Children under 10 years of age with dyslipidaemia unresponsive to appropriate lifestyle interventions.
- Children with inadequate response to statins.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 7: Endocrine, 7.5 Diabetes Mellitus, 7.5.2 Diabetes Mellitus, Insulin Dependent: Acute Complications, 7.5.2.5 Dyslipidaemia