Pediatric Dyslipidemia in a Minority Mostly-Immigrant Inner City Population

Background
Childhood dyslipidemia and obesity have been associated with increased risk of lifelong atherosclerosis and adverse cardiovascular outcomes. Age appropriate universal or risk-based selective lipid screening is now recommended for early disease identification. Despite screening, the true burden of pediatric dyslipidemia has been masked by paucity of published data.

Aim
to compare the prevalence of dyslipidemia and obesity in the South Bronx pediatric population to national prevalence and to explore the association between childhood obesity and risk of dyslipidemia.

Methods
We conducted a retrospective chart review of children aged 3-21 years who had lipid screening at the Bronx-Lebanon Hospital Center pediatric outpatient clinic from June 2012 to June 2017. Study was IRB-approved and data was obtained using ICD-9 and 10 codes for key words. Dyslipidemia was defined as any derangement in total cholesterol (Tc), non-high-density-Lipoprotein-cholesterol (n-HDLc) or low-density-lipoprotein-cholesterol (LDLc) levels. We calculated mean serum levels for Tc, n-HDLc, LDLc, and Triglycerides (TG), while BMI was categorized based on age and gender specific percentiles. Serum lipid cut-offs were based on AAP Expert Panel recommendations, while data on national prevalence was based on NHANES and CDC data. Chi-square test of proportions and Logistic regression were used to compare prevalence and test associations at α=0.05 significance level using SAS 9.3®.

Results
Records for 8644 children were reviewed - half were male (50.1%) and mean age was 13 years. Majority (82%) identified as Black or Hispanic, with 47% of the population having BMI ≥ 95th percentile. In general, compared to national data, South Bronx pediatric population showed a significantly higher prevalence of dyslipidemia (29% vs. 20%, p<0.0001) and Obesity (47% vs. 21%, p<0.0001) (Table 1). Compared to subjects with normal BMI, obese (OR=1.6, 95%CI=1.46-1.75) and overweight (OR=1.08, 95%CI= 0.96-1.21) subjects had increased likelihood of dyslipidemia. About 1% (86/8644) required use of statins or immediate referral to a specialist due to very high LDL or TG levels.
Conclusion
There is a higher prevalence of dyslipidemia in the South Bronx pediatric population compared to national prevalence, placing this population at risk of adverse cardiovascular health outcomes. Targeted public health and patient-level interventions are needed to reduce the risk of adverse cardiovascular events in this population.