ESPE Yearbook of Paediatric Endocrinology

Nat Rev Cardiol. 2022, 19(8):543-554. doi: 10.1038/s41569-021-00647-9

This review discusses the role of apo-lipoprotein B (apoB)-containing lipoproteins (commonly estimated by LDL cholesterol) in the process of atherosclerosis throughout the life-course. The authors comprehensively describe the development of atherosclerosis according to the response-to-retention hypothesis, and they present data from large-scale, intensive lifestyle intervention studies including children and adults showing moderate improvements in LDL cholesterol levels. However, substantial reductions in LDL cholesterol levels and a likely subsequent reduction in cardiovascular disease risk may only be achievable by wide use of pharmaceutical treatments, particularly statins.

The authors address the current dilemma when to use statins for primordial, and primary cardiovascular disease prevention in otherwise healthy children. Knowledge gaps include evidence on long-term safety of pharmaceutical therapies, data on effects from dietary and lifestyle interventions begun in childhood on adult cardiovascular morbidity and mortality, and missing data on possible crucial ages when risk factors have a particularly strong effect. Another key issue is that there is no consensus among the guidelines on screening strategies for dyslipidaemia in childhood.

The authors conclude that, in theory, cardiovascular diseases could be eradicated if the development of atherosclerosis could be prevented by sustaining healthy serum LDL cholesterol levels from childhood to adulthood. Consequently, future studies should aim at providing the evidence required to reach a consensus on strategies to identify and manage individuals at high risk of atherosclerosis, as the means to prevent this are seemingly present.