Diagnostic Criteria and Lipid Screening of Dyslipidemia in Children

Obesity is associated with significant morbidities and life-threatening conditions. Evidence shows that obesity in the pediatric population has increased by ten folds recently. This has been attributed to the remarkable recent alternations in socioeconomic factors and the overall increase in the incidence of obesity among the different populations. The pathogenesis of atherosclerosis and cardiovascular diseases is usually initiated in childhood. Previous studies indicates that early identification and proper treatment of dyslipidemia in the pediatric population can significantly reduce the risk of developing cardiovascular diseases and associated morbidities. Therefore, it is vital to screen children's lipid profiles to identify dyslipidemia and apply better interventions. This can significantly reduce the risk of premature cardiovascular diseases and accelerated atherosclerosis. The present study aims to identify the diagnostic criteria and various lipid screening approaches proposed in the literature to identify dyslipidemia in children. Two main approaches for screening dyslipidemia in children were reported. These include universal and selective screening approaches. While the latter is recommended to identify high-risk children, universal screening is also recommended to identify children missed by targeted screening (usually treated by pharmacological modalities).

Racial/Ethnic Disparities in Screening for and Awareness of High Cholesterol Among Pregnant Women Receiving Prenatal Care

Background Atherosclerotic cardiovascular disease remains a leading cause of morbidity and mortality among women, with younger women being disproportionately affected by traditional cardiovascular risk factors such as dyslipidemia. Despite recommendations for lipid screening in early adulthood and the risks associated with maternal dyslipidemia during pregnancy, many younger women lack access to and utilization of early screening. Accordingly, our objective was to assess the prevalence of and disparities in lipid screening and awareness of high cholesterol as an atherosclerotic cardiovascular disease risk factor among pregnant women receiving prenatal care. Methods and Results We invited 234 pregnant women receiving prenatal care at 1 of 3 clinics affiliated with the University of Pennsylvania Health System to complete our survey. A total of 200 pregnant women (86% response rate) completed the survey. Overall, 59% of pregnant women (mean age 32.2 [±5.7] years) self‐reported a previous lipid screening and 79% of women were aware of high cholesterol as an atherosclerotic cardiovascular disease risk factor. Stratified by racial/ethnic subgroups, non‐Hispanic Black women were less likely to report a prior screening (43% versus 67%, P =0.022) and had lower levels of awareness (66% versus 92%, P <0.001) compared with non‐Hispanic White women. Non‐Hispanic Black women were more likely to see an obstetrician/gynecologist for their usual source of non‐pregnancy care compared with non‐Hispanic White women (18% versus 5%, P =0.043). Those seeing an obstetrician/gynecologist for usual care were less likely to report a prior lipid screening compared with those seeing a primary care physician (29% versus 63%, P =0.007). Conclusions Significant racial/ethnic disparities persist in lipid screening and risk factor awareness among pregnant women. Prenatal care may represent an opportunity to enhance access to and uptake of screening among younger women and reduce variations in accessing preventive care services.

Exploration of fatty acid methyl esters (FAME) in cyanobacteria for a wide range of algae-based biofuels

Due to high demand in the industry field, fuel supply has been reduced due to overconsumption. Algae served as the most promising biofuels; Cyanobacteria is preferred as a material for producing biodiesel based on the comparative advantage. Cyanobacteria can produce high lipids profiles that can be used to produce biofuel or biodiesel. The present investigation aimed to identify the application of Cyanobacteria that have proposed lipid standards for the algae biofuel industry. Three main objectives are involved in these experiments: to isolate and identify different strains of Cyanobacteria, convert the lipid from microalgae into biodiesel through transesterification, and estimate the proposed lipid standard of Cyanobacteria for the algae biofuel industry. The microalgae involve isolated using a plankton net. The water sample is brought into the lab for the identification of Cyanobacteria. After the Cyanobacteria are identified, the Cyanobacteria undergo mass cultivation to ensure the biomass is enough for lipid screening. After lipid content is identified, the lipid in the Cyanobacteria is extracted and further transesterification process. The GC analysis showed the variation of fatty acid in this cyanobacterium, a saturated, monounsaturated, and polyunsaturated fatty acid. The study also revealed that hexadecanoic acid, pentadecanoic acid and pentadecanoic acid was found in Oscillatoria sp. Lipid screening can determine the quantity of lipid present in the Cyanobacteria to estimate the lipid content for biofuel production.

Abstract 14681: Comparative Study Between International Guidelines in Detecting Pediatric Familial Hypercholesterolemia Through a Unique Community Health System in Kagawa, Japan

Introduction: Familial hypercholesterolemia (FH) is an autosomal hereditary disease found in patients who have elevated low-density lipoprotein cholesterol (LDL-C) from birth. Early detection and treatment of FH during childhood potentially reduces the risk of premature cardiovascular events. In Kagawa prefecture, a unique community health system, involving three steps, has been conducted to prevent lifestyle-related diseases for 10-year-old children. This system includes universal lipid screening, selection by pediatricians, and next-generation sequencing (NGS) of FH-related genes in hospitals. The aim of this study is to compare 3 international guidelines to detect pediatric FH with this unique community health system in Kagawa. Methods: In Kagawa prefecture, the universal lipid screening of approximately 8,000 children at 10 years of age is performed annually, covering over 90% of the target group. After excluding secondary hypercholesterolemia, pediatric clinics introduced children with LDL-C >140mg/dL to 4 designated hospitals to perform NGS. We applied the guidelines of the Dutch Lipid Clinic Network (DLCN), Simon Broome (SB), and the Japanese Atherosclerosis Society (JAS) to children who received NGS in the unique community health system in Kagawa. Results: We performed NGS for 46 children from January 2018 to February 2020 (LDL-C 186.0±50.3 mg/dL; Male/F 27/19) and 26 (57%) had FH genetic mutations (23 LDL-R and 3 PCSK9 mutations). Seventeen children met FH criteria for DLCN (35%), 10 for Simon Broome (22%), and 11 for JAS (24%), respectively. The combination of NGS and either of the 3 guidelines increased the number of children diagnosed as FH up to 31 (67%). Conclusion: International guidelines detected only half of pediatric FH who were diagnosed by the unique community health system in Kagawa. Further investigation will be required to build an effective universal screening system for pediatric FH.

Abstract 14696: The Effectiveness of a Unique Community Health System in Detecting Familial Hypercholesterolemia in Kagawa, Japan

Introduction: Familial hypercholesterolemia (FH) is an autosomal hereditary disease found in patients who have elevated low-density lipoprotein cholesterol (LDL-C) levels from birth. Early detection and treatment of FH during childhood potentially reduces the risk of premature cardiovascular events. In Kagawa prefecture, a unique community health system, involving three steps, has been conducted to prevent lifestyle-related diseases for 10-year-old children. This system includes universal lipid screening, selection by pediatricians, and next-generation sequencing (NGS) of FH-related genes in the hospitals. The aim of this study is to investigate whether this system can be effective in detection of FH. Methods: In Kagawa prefecture, the universal lipid screening of children at 10 years of age is performed annually at school, covering over 90% of the target group. After excluding secondary hypercholesterolemia, pediatric clinics introduced children with LDL-C levels >140 mg/dL to four hospitals to perform NGS to detect FH. Results: In 2017, 279 children (3.7%) showed elevated LDL-C >140mg/dL among 7,647 ones who received the screening. We performed NGS for 46 children after excluding secondary hypercholesterolemia by pediatricians (LDL-C 186.0±50.3 mg/dL; M/F 27/19) and 26 children (57%) had FH genetic mutations (23 LDL-R, 3 PCSK9). The children with LDL-C >180mg/dL are recommended to receive statin therapy according to the guideline from the Japanese Atherosclerosis Society (JAS). Children with LDL-C levels ≥180 mg/dL have 74% of positive genetic mutations, and even those with 140-180 mg/dl LDL-C levels have as much as 44%, respectively (Table). Conclusions: The unique community health system in Kagawa can efficiently detect FH of children. Further investigation will be required for the effective prevention of future atherosclerotic cardiovascular diseases.