The hyperlipoproteinemias in adolescence

Although overt clinical manifestations of hyperlipidemia are uncommon during adolescence, several factors make it important for physicians dealing with this age group to be familiar with the implications, identification, and management of hyperlipidemia. First, epidemiologic studies have demonstrated an association between premature atherosclerotic vascular disease and elevated levels of serum lipids; prevention of these atherosclerotic complications is the major goal in the treatment of hyperlipidemia. Myocardial infarctions occur at an earlier age in patients with hypercholesterolemia than in those with hypertriglyceridemia. Elevations of both cholesterol and triglycerides carry the greatest risk of coronary artery disease. Since advanced atherosclerotic changes were found in the coronary arteries of young soldiers killed in Korea, preventive measures may be most effective when started during childhood or adolescence. Second, some adolescents do exhibit clinical manifestations of hyperlipidemia. Hypercholesterolemic patients may have xanthelasma or arcus senilis. Adolescents with familial hypercholesterolemia may develop tendinous xanthomas, and homozygotes for this disorder have extreme hypercholesterolemia which leads to death from myocardial infarction in the teens or earlier. Severe hypertriglyceridemia at any age produces eruptive xanthomas and abdominal pain from acute pancreatitis. Third, hyperlipidemia is fairly common in adolescents. Its exact prevalence is unknown, but estimates suggest that about 0.5% of the adults in this country have a familial hyperlipidemia. Secondary hyperlipidemia occurs even more frequently. Finally, identification of hyperlipidemia in an adolescent has significant implications for siblings and parents, who may also be affected with a familial hyperlipidemia.