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Schillaci G, Pasqualini L, Verdecchia P, Vaudo G, Marchesi S, Porcellati C, et al. Prognostic significance of left ventricular diastolic dysfunction in essential hypertension. J Am Coll Cardiol 2002; 39(12): 2005–2011. Society Consensus Statement on new treatments and clinical guidance on familial hypercholesterolaemia. This preventative approach emphasises early detection, management of lifestyle choices and commencement of therapies where necessary. Strong evidence suggests that children with elevated cholesterol levels are at risk of death in their mid-forties. The screening for cholesterol at age 40 years is extremely late and damage to the vascular and cardiac organs is likely irreversible. In the paediatric population, clinical trials and simulated intervention studies have shown that dyslipidaemia-related atherosclerosis is completely reversible if detection, prevention and treatment are commenced early. Unfortunately, adopting a universal approach to preventing atherosclerotic cardiovascular disease from childhood has been unprecedentedly slow, with every 30 seconds wasted in indecision leading to another life lost in the future. In this viewpoint, a public health prevention tool that has been used previously in tackling infectious diseases such as polio, smallpox and covid-19 was proposed. Elevated cholesterol levels and dyslipidaemia, although a non-communicable risk factor, has a spreading pattern akin to an infectious disease, as it could affect a household, neighbourhood and community, for instance, through poor diet and lifestyle habits. ‘To combat the world’s deadliest disease, a public health weapon might be necessary due to the urgency of this threat to human existence. Recommendations to screen children by age two years are being proposed, which would detect familial hypercholesterolaemia. However, the development of elevated cholesterol levels in adolescence without genetic predisposition is of equal priority as only one in 200 adolescents with elevated cholesterol levels might have received treatment,’ says Andrew Agbaje, a physician and clinical epidemiologist at the University of Eastern Finland. ‘Using the principle of vaccination or immunisation card for infectious diseases, an adolescent cholesterol passport could be adopted on a global scale with specific timeline schedules for cholesterol screening. Prior to applying for a first driver’s licence or writing the final examination in high school, adolescents should have their first cholesterol assessment. This should be repeated once every 10 years until age 40 years, and documented in the cholesterol passport. It was recently shown that 2.53 qualityadjusted life years could be gained per person if detection and treatment are commenced early, especially in children with familial hypercholesterolemia,’ Agbaje continues. ‘It is likely that a universal adoption of adolescent cholesterol passport may reduce health disparities, since people with a low socio-economic status suffer disproportionately from atherosclerotic cardiovascular disease. Future generations beckon us to summon the courage to combat dyslipidaemia-related atherosclerosis by first establishing and implementing a universal paediatric lipid screening. Therefore, public health experts, paediatricians, health journalists and health policymakers should help disseminate this information as a matter of urgency,’ Agbaje concludes. Dr Agbaje’s research group (urFIT-child) is supported by research grants from Jenny and Antti Wihuri Foundation, the Finnish Cultural Foundation Central Fund, the Finnish Cultural Foundation North Savo Regional Fund, the Orion Research Foundation, the Aarne Koskelo Foundation, the Antti and Tyyne Soininen Foundation, the Paulo Foundation, the Yrjö Jahnsson Foundation, the Paavo Nurmi Foundation, the Finnish Foundation for Cardiovascular Research, Ida Montin Foundation, and the Foundation for Pediatric Research. https://uefconnect.uef.fi/en/person/andrew.agbaje/ Continued from page 3
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