# Clinical and Subclinical Atherosclerotic Disease in Adolescents With Familial Hypercholesterolemia

## TL;DR

This paper discusses atherosclerotic disease in adolescents with a genetic condition causing high cholesterol, highlighting challenges in diagnosis and treatment.

## Contribution

The paper presents case studies of adolescents with familial hypercholesterolemia and atherosclerosis, emphasizing unique management strategies.

## Key findings

- Adolescents with familial hypercholesterolemia can develop coronary artery disease despite available treatments.
- Plasma exchange and drug-eluting stents were used in managing LDL cholesterol and revascularization.
- Subclinical atherosclerosis was detected in one adolescent with confirmed genetic diagnosis.

## Abstract

Familial hypercholesterolemia is primarily a disorder of reduced low-density lipoprotein (LDL) clearance, which can be inherited in either homozygous or heterozygous form. Despite the availability of various modalities to achieve target LDL cholesterol levels, inadequate control remains a significant risk factor for accelerated atherosclerosis in the pediatric population. Moreover, the occurrence of coronary artery disease in adolescents poses unique management challenges given the limited representation of this age group in clinical trials. We report 2 cases of coronary artery disease and 1 case of subclinical atherosclerosis in adolescent patients with genetically confirmed familial hypercholesterolemia, outlining the diagnostic work-up, challenges in achieving LDL cholesterol control, measures undertaken, including plasma exchange, and revascularization strategies using drug-eluting stents or drug-coated balloons, in accordance with current guidelines.