Adults should be wary, but children need to pay even more attention: Analysis of the dual harms of hyperlipidemia

The dangers of hyperlipidemia to the human body should be taken seriously: Statistics show that over 2 million people die from cardiovascular and cerebrovascular diseases in my country each year, accounting for 40% of all deaths, ranking first among all causes of death and thus being called the "number one killer" threatening human life and health. The most serious consequence of hyperlipidemia is atherosclerosis, damaging the cardiovascular system and leading to serious diseases such as coronary heart disease, myocardial infarction, hypertension, cerebral infarction, and cerebral atrophy. Epidemiological statistics show that coronary heart disease accounts for 10% to 20% of deaths from heart disease in my country; in developed countries, the mortality rate of coronary heart disease has exceeded that of cancer, and the prevalence of hypertension among the elderly aged 60-70 exceeds 20%, and over 50% among those over 70. Cardiovascular and cerebrovascular diseases caused by hyperlipidemia are the main culprits behind high morbidity, high disability rate, and high mortality rate in humans.

Furthermore, it is worth noting the impact of blood lipid levels. Numerous studies have shown that women have a much better tolerance to cholesterol than men, while men have a better tolerance to triglycerides than women. In other words, 90% of women with elevated triglycerides are prone to coronary heart disease, while elevated cholesterol is the most significant risk factor for coronary heart disease in men.

The impact of hyperlipidemia on children should be taken seriously: Many people believe that hyperlipidemia only affects middle-aged and elderly people, and that children and adolescents are completely immune. This is not the case. Hyperlipidemia can occur at any age, and children and adolescents can also develop it. There is currently no definitive conclusion regarding normal blood lipid levels in children. In 1970, Japan measured blood lipid levels in children across various regions and proposed normal reference values ​​based on these measurements. These standards are: total cholesterol (TC) ≥ 5.2 mmol/L, triglycerides (TG) ≥ 1.76 mmol/L, low-density lipoprotein cholesterol (LDL-C) ≥ 3.38 mmol/L, and high-density lipoprotein cholesterol (HDL-C) ≤ 1.04 mmol/L. Based on these diagnostic criteria, the incidence of hyperlipidemia in children is very high.

Children's lipid metabolism differs from that of normal adults, and pediatric lipid metabolism disorders have their own characteristics. Primary pediatric lipid metabolism disorders are mainly caused by congenital gene defects. Although some familial hyperlipidemias do not manifest obviously in childhood and adolescence, lipoprotein metabolism disorders caused by severe defects can be detected in childhood. For example, type I hyperlipidemia (hyperchylomicronemia) is an autosomal recessive genetic disorder, with more than 65% of patients developing the disease before the age of 10. Plasma triglyceride levels can rise to over 11.3 mmol/L, even reaching as high as 113 mmol/L, and very low-density lipoprotein cholesterol (VLDL-C) can be as high as 3.9–10.4 mmol/L, while high-density lipoprotein cholesterol (HDL-C) can drop to 0.2–0.5 mmol/L. In some children, fresh serum appears milky white and turbid. After being refrigerated overnight at 4°C, the serum shows obvious stratification, with the upper layer being milky and the lower layer being clear and transparent. Type II hyperlipidemia (hyper-B-lipoproteinemia) is a familial hypercholesterolemia inherited in an autosomal dominant pattern. Heterozygous individuals will have hypercholesterolemia before age 10, while homozygous individuals will have hypercholesterolemia at birth. Elevated low-density lipoprotein cholesterol (LDL-C) is its main characteristic, and corneal rings and tendon xanthomas can appear as early as age 4.

The above describes primary pediatric lipid metabolism disorders. Secondary hyperlipidemia is more likely to occur in children. If a child's plasma LDL-C is greater than 3.4 mmol/L (130 mg%), the possibility of secondary hyperlipoproteinemia has been ruled out. Clinically, the causes of secondary hyperlipoproteinemia are not singular; conditions such as diabetes, nephrotic syndrome, liver disease, hypothyroidism, and obesity can all lead to secondary hyperlipoproteinemia. Obesity and kidney disease are relatively common causes in clinical practice. A domestic study of 66 children with simple obesity found that their plasma total cholesterol, apolipoprotein B, and low-density lipoprotein cholesterol levels were significantly higher than those of normal-weight children. Data showed that children with nephrotic syndrome had significantly higher plasma cholesterol levels than normal children, with elevated levels of very low-density lipoprotein cholesterol and low-density lipoprotein cholesterol, while high-density lipoprotein cholesterol levels were normal or slightly lower – this was their main characteristic. In addition, triglycerides were also elevated.

These findings indicate that childhood hyperlipidemia not only exists but is quite common. As people's living standards continue to improve, the number of overweight children in families and schools is increasing, especially those with childhood hyperlipidemia, which deserves special attention from society. While effectively adjusting the diets of these overweight children, it is essential to remember to conduct necessary blood lipid monitoring.