Recognition of familial dyslipidemias in 5-year-old children using the lipid phenotypes of parents

The STRIP project


      Adult dyslipidemias may reveal familial and, therefore, offspring dyslipidemias. We evaluated the prevalences of the adult-offspring dyslipidemias in 441 general population families composed of both parents and one 5-year-old child. Family members were classified using the 90th or 10th percentiles for hypercholesterolemia (IIA), hypertriglyceridemia (IV), combined hyperlipidemia (IIB), and low high density lipoprotein cholesterol concentration without hyperlipidemia (hypoHDL). In familial combined hyperlipidemia (FCHL), the IIB-phenotype was in one generation and one of the three hyperlipidemias in the other generation. Finally, the parental dyslipidemia phenotypes and elevated lipids (>80th percentile) that reveal offspring dyslipidemia were selected by stepwise logistic regression. Either the IIA-, IV- or hypoHDL phenotype was found in both generations in 2.8, 2.0 and 1.4% of the families, respectively. FCHL was seen in 1.8% of the families, which confirms the earlier views. The predictive values of the elevated parental cholesterol, type IV or hypoHDL parents to find type IIA, IV and hypoHDL children were low for systematic screening: 16, 13 and 15%, respectively. However, 44% of the children of IIB parents expressed hyperlipidemia (odds ratio 4.7, P=0.006). The IIB phenotype of the parent is a good predictor of the child's hyperlipidemia, and when encountered, it indicates that the lipids of the child should be studied. This would be as important as selective screening of familial hypercholesterolemia.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jacobson M.S.
        Heart healthy diets for all children: no longer controversial.
        J. Pediatr. 1998; 133: 1
        • Rask-Nissilä L.
        • Jokinen E.
        • Terho P.
        • et al.
        Neurological development of 5-year-old children receiving a low-saturated fat, low-cholesterol diet since infancy: a randomized controlled trial.
        J. Am. Med. Ass. 2000; 284: 993
      1. National Cholesterol Education Programs: report of the expert panel on blood cholesterol levels in children and adolescents, Pediatrics 89 Suppl., 1992 525.

        • Kwiterovich Jr., P.O.
        Diagnosis and management of familial dyslipoproteinemia in children and adolescents.
        Pediatr. Clin. North Am. 1990; 37: 1489
        • Niinikoski H.
        • Viikari J.
        • Rönnemaa T.
        • et al.
        Prospective randomized trial of low-saturated-fat, low-cholesterol diet during the first 3 years of life. The STRIP baby project.
        Circulation. 1996; 94: 1386
        • Koivisto P.
        • Koivisto U.-M.
        • Miettinen T.
        • Kontula K.
        Diagnosis of heterozygous familial hypercholesterolemia DNA analysis complements clinical examination and analysis of serum lipid levels.
        Arterioscler. Thromb. Vasc. Biol. 1992; 12: 584
        • Salo P.
        • Viikari J.
        • Rask-Nissilä L.
        • et al.
        Effect of low-saturated fat, low-cholesterol dietary intervention on fatty acid compositions in serum lipid fractions in 5-year-old children. The STRIP project.
        Eur. J. Clin. Nutr. 1999; 53: 927
        • Friedewald W.T.
        • Levy R.
        • Fredrickson D.S.
        Estimation of the concentration of low-density lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge.
        Clin. Chem. 1972; 18: 499
        • Sorva R.
        • Perheentupa J.
        • Tolppanen E.M.
        A novel format for a growth chart.
        Acta Pediatr. Scand. 1984; 73: 527
        • SAS Institute Inc
        SAS/STAT User's Guide. SAS Institute Inc, Cary1998
        • Porkka K.V.
        • Viikari J.S.
        • Taimela S.
        • Dahl M.
        • Åkerblom H.K.
        Tracking and predictiveness of serum lipid and lipoprotein measurements in childhood: a 12-year follow-up. The Cardiovascular Risk in Young Finns study.
        Am. J. Epidemiol. 1994; 140: 1096
        • Genest Jr., J.J.
        • Martin-Munley S.S.
        • McNamara J.R.
        • et al.
        Familial lipoprotein disorders in patients with premature coronary artery disease.
        Circulation. 1992; 85: 2025
        • Diller P.M.
        • Huster G.A.
        • Leach A.D.
        • Laskarzewski P.M.
        • Sprecher D.L.
        Definition and application of the discretionary screening indicators according to the National Cholesterol Education Program for Children and Adolescents.
        J. Pediatr. 1995; 126: 345
        • Sprecher D.L.
        • Feigelson H.S.
        • Laskarzewski P.M.
        The low HDL cholesterol/high triglyceride trait.
        Arterioscler. Thromb. Vasc. Biol. 1993; 13: 495
        • Assmann G.
        • Schulte H.
        Relation of high-density lipoprotein cholesterol and triglycerides to incidence of atherosclerotic coronary artery disease (the PROCAM Experience).
        Am. J. Cardiol. 1992; 70: 733
        • Nikkilä E.A.
        • Aro A.
        Family study of serum lipids and lipoproteins in coronary heart disease.
        Lancet. 1973; 1: 954
        • Goldstein J.L.
        • Schrott H.G.
        • Hazzard W.R.
        • Bierman E.L.
        • Motulsky A.G.
        Hyperlipidemia in coronary heart disease. II. Genetic analysis of lipid levels in 176 families and delineation of a new inherited disorder, combined hyperlipidemia.
        J. Clin. Invest. 1973; 52: 1544
        • Grundy S.M.
        • Chait A.
        • Brunzell J.D.
        Familial combined hyperlipidemia workshop.
        Arteriosclerosis. 1987; 7: 203
        • Porkka K.V.K.
        • Nuotio I.
        • Pajukanta P.
        • et al.
        Phenotype expression in familial combined hyperlipidemia.
        Atherosclerosis. 1997; 133: 245
        • Austin M.A.
        • McKnight B.
        • Edwards K.L.
        • et al.
        Cardiovascular disease mortality in familial forms of hypertriglyceridemia: a 20-year prospective study.
        Circulation. 2000; 101: 2777
        • Pitkänen O.-P.
        • Nuutila P.
        • Raitakari O.T.
        • et al.
        Coronary flow reserve in young men with familial combined hyperlipidemia.
        Circulation. 1998; 99: 1678
        • Karhapää P.
        • Voutilainen E.
        • Malkki M.
        • Laakso M.
        Obese men with type IIB hyperlipidemia are insulin resistant.
        Arterioscler. Thromb. Vasc. Biol. 1993; 13: 1469
        • Chen W.
        • Srinivasan S.R.
        • Bao W.
        • Wattigney W.A.
        • Berenson G.S.
        The relationship of conjoint traits of dyslipidemias between young offspring and their parents in a community-based sample.
        Prev. Med. 1997; 26: 717
        • Bhatnagar D.
        • Morgan J.
        • Siddiq S.
        • Mackness M.I.
        • Miller J.P.
        • Durrington P.N.
        Outcome of case finding among relatives of patients with known heterozygous familial hypercholesterolaemia.
        Br. Med. J. 2000; 321: 1497
        • Pajukanta P.
        • Nuotio I.
        • Terwilliger J.D.
        • et al.
        Linkage of familial combined hyperlipidaemia to chromosome 1q21-q23.
        Nat. Genet. 1998; 18: 369
        • Braveman P.A.
        • Tarimo E.
        Screening in primary health care: setting priorities with limited resources. World Health Organization, Geneva1994