Pub Date : 2025-04-07DOI: 10.1016/s2352-4642(25)00041-0
Megan A Moreno,Jenny Radesky,Nicole Owings-Fonner
{"title":"Navigating the complexities of adolescent health and social media.","authors":"Megan A Moreno,Jenny Radesky,Nicole Owings-Fonner","doi":"10.1016/s2352-4642(25)00041-0","DOIUrl":"https://doi.org/10.1016/s2352-4642(25)00041-0","url":null,"abstract":"","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":"139 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-05-14DOI: 10.1016/S2352-4642(24)00102-0
Marian J Bakermans-Kranenburg, Marinus H van IJzendoorn
{"title":"Monitoring change from residential housing care to family-based care for children.","authors":"Marian J Bakermans-Kranenburg, Marinus H van IJzendoorn","doi":"10.1016/S2352-4642(24)00102-0","DOIUrl":"10.1016/S2352-4642(24)00102-0","url":null,"abstract":"","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":"549-550"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140961265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-05-14DOI: 10.1016/S2352-4642(24)00105-6
Ari Horton
{"title":"Lipoprotein apheresis and long-term cardiovascular health: a real answer for children with HoFH?","authors":"Ari Horton","doi":"10.1016/S2352-4642(24)00105-6","DOIUrl":"10.1016/S2352-4642(24)00105-6","url":null,"abstract":"","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":"468-469"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140961262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-05-14DOI: 10.1016/S2352-4642(24)00073-7
M Doortje Reijman, Tycho R Tromp, Barbara A Hutten, G Kees Hovingh, Dirk J Blom, Alberico L Catapano, Marina Cuchel, Eldad J Dann, Antonio Gallo, Lisa C Hudgins, Frederick J Raal, Kausik K Ray, Fouzia Sadiq, Handrean Soran, Jaap W Groothoff, Albert Wiegman, D Meeike Kusters
<p><strong>Background: </strong>Homozygous familial hypercholesterolaemia (HoFH) is a rare genetic disease characterised by extremely high plasma LDL cholesterol from birth, causing atherosclerotic cardiovascular disease at a young age. Lipoprotein apheresis in combination with lipid-lowering drugs effectively reduce LDL cholesterol, but long-term health outcomes of such treatment are unknown. We aimed to investigate the long-term cardiovascular outcomes associated with lipoprotein apheresis initiated in childhood or adolescence.</p><p><strong>Methods: </strong>In this cohort study, data were drawn from the HoFH International Clinical Collaboration (HICC) and the international registry for Children with Homozygous Hypercholesterolemia on Lipoprotein Apheresis (CHAIN). An overall cohort included patients diagnosed with HoFH aged 0-18 years who were alive and in follow-up between Jan 1, 2010, and Nov 8, 2021, and whose high plasma LDL cholesterol concentrations made them eligible for lipoprotein apheresis. To compare cardiovascular outcomes, patients who initiated lipoprotein apheresis in childhood (lipoprotein apheresis group) and patients who only received lipid-lowering drugs (pharmacotherapy-only group) were matched by sex and untreated plasma LDL cholesterol concentrations. The primary outcome was a composite of cardiovascular death, myocardial infarction, ischaemic stroke, percutaneous coronary intervention, coronary artery bypass grafting, aortic valve replacement, peripheral artery disease, carotid endarterectomy, angina pectoris, and supra-aortic or aortic stenosis (collectively referred to as atherosclerotic cardiovascular disease), for which survival analyses were performed in the matched cohort. Cox regression analyses were used to compare disease-free survival between cohorts and to calculate hazard ratio (HR) and 95% CI adjusted for sex, age at diagnosis, untreated plasma LDL cholesterol concentration, and number of lipid-lowering therapies other than lipoprotein apheresis.</p><p><strong>Findings: </strong>The overall cohort included 404 patients with a median age at diagnosis of 6·0 years (IQR 3·0-9·5) and median untreated plasma LDL cholesterol of 17·8 mmol/L (14·7-20·8). The matched cohorts included 250 patients (125 patients per group), with a median untreated LDL cholesterol of 17·2 mmol/L (14·8-19·7). Mean reduction in plasma LDL cholesterol concentrations between baseline and final follow-up was greater in the lipoprotein apheresis group (-55% [95% CI -60 to -51] vs -31% [-36 to -25]; p<0·0001). Patients in the lipoprotein apheresis group had longer atherosclerotic cardiovascular disease-free survival (adjusted HR 0·52 [95% CI 0·32-0·85]) and longer cardiovascular death-free survival (0·0301 [0·0021-0·4295]). Cardiovascular death was more common in the pharmacotherapy-only group than in the lipoprotein apheresis group (ten [8%] vs one [1%]; p=0·010), whereas median age at coronary artery bypass grafting was lower in the lipopro
背景：同卵家族性高胆固醇血症（HoFH）是一种罕见的遗传疾病，其特点是出生时血浆中的低密度脂蛋白胆固醇就极高，导致患者在年轻时就患上动脉粥样硬化性心血管疾病。脂蛋白分离术与降脂药物联合使用可有效降低低密度脂蛋白胆固醇，但这种治疗的长期健康效果尚不清楚。我们旨在研究儿童或青少年时期开始的脂蛋白清除术对心血管的长期影响：在这项队列研究中，数据来自于HoFH国际临床合作组织（HICC）和 "接受脂蛋白分离治疗的高胆固醇血症患儿国际登记处"（CHAIN）。总体队列包括2010年1月1日至2021年11月8日期间存活并接受随访的0-18岁确诊为HoFH的患者，这些患者的血浆低密度脂蛋白胆固醇浓度较高，符合脂蛋白分离治疗的条件。为了比较心血管预后，在儿童期开始接受脂蛋白清除术的患者（脂蛋白清除术组）和只接受降脂药物治疗的患者（单纯药物治疗组）按性别和未经治疗的血浆低密度脂蛋白胆固醇浓度进行了配对。主要结果是心血管死亡、心肌梗死、缺血性中风、经皮冠状动脉介入治疗、冠状动脉旁路移植术、主动脉瓣置换术、外周动脉疾病、颈动脉内膜切除术、心绞痛、主动脉上或主动脉狭窄（统称为动脉粥样硬化性心血管疾病）的综合结果，并对匹配队列进行了生存分析。采用 Cox 回归分析比较不同队列之间的无病生存率，并计算危险比（HR）和 95% CI（根据性别、诊断时的年龄、未经治疗的血浆低密度脂蛋白胆固醇浓度以及除脂蛋白清除术以外的降脂疗法次数进行调整）：总体队列包括 404 名患者，诊断时的中位年龄为 6-0 岁（IQR 3-0-9-5），未经治疗的血浆低密度脂蛋白胆固醇中位数为 17-8 mmol/L (14-7-20-8)。配对队列包括 250 名患者（每组 125 名患者），未经治疗的低密度脂蛋白胆固醇中位数为 17-2 mmol/L (14-8-19-7)。从基线到最终随访期间，脂蛋白分离组血浆低密度脂蛋白胆固醇浓度的平均降幅更大（-55% [95% CI -60 to -51] vs -31% [-36 to -25]；p解释：在HoFH患者中，儿童和青少年时期开始进行脂蛋白清除术与降低动脉粥样硬化性心血管疾病和死亡的长期风险有关，并且发现早期开始高频治疗对降低血浆胆固醇有明显益处。现在需要达成共识建议，以指导更广泛、更及时地使用脂蛋白清除术治疗HoFH患儿，还需要开展研究以进一步优化治疗，确保早期积极治疗的益处与对生活质量的影响相平衡：阿姆斯特丹大学医学中心、位置学术医学中心、宾夕法尼亚大学佩雷尔曼医学院、欧洲动脉粥样硬化协会、美国国立卫生研究院国家心肺血液研究所。
{"title":"Cardiovascular outcomes in patients with homozygous familial hypercholesterolaemia on lipoprotein apheresis initiated during childhood: long-term follow-up of an international cohort from two registries.","authors":"M Doortje Reijman, Tycho R Tromp, Barbara A Hutten, G Kees Hovingh, Dirk J Blom, Alberico L Catapano, Marina Cuchel, Eldad J Dann, Antonio Gallo, Lisa C Hudgins, Frederick J Raal, Kausik K Ray, Fouzia Sadiq, Handrean Soran, Jaap W Groothoff, Albert Wiegman, D Meeike Kusters","doi":"10.1016/S2352-4642(24)00073-7","DOIUrl":"10.1016/S2352-4642(24)00073-7","url":null,"abstract":"<p><strong>Background: </strong>Homozygous familial hypercholesterolaemia (HoFH) is a rare genetic disease characterised by extremely high plasma LDL cholesterol from birth, causing atherosclerotic cardiovascular disease at a young age. Lipoprotein apheresis in combination with lipid-lowering drugs effectively reduce LDL cholesterol, but long-term health outcomes of such treatment are unknown. We aimed to investigate the long-term cardiovascular outcomes associated with lipoprotein apheresis initiated in childhood or adolescence.</p><p><strong>Methods: </strong>In this cohort study, data were drawn from the HoFH International Clinical Collaboration (HICC) and the international registry for Children with Homozygous Hypercholesterolemia on Lipoprotein Apheresis (CHAIN). An overall cohort included patients diagnosed with HoFH aged 0-18 years who were alive and in follow-up between Jan 1, 2010, and Nov 8, 2021, and whose high plasma LDL cholesterol concentrations made them eligible for lipoprotein apheresis. To compare cardiovascular outcomes, patients who initiated lipoprotein apheresis in childhood (lipoprotein apheresis group) and patients who only received lipid-lowering drugs (pharmacotherapy-only group) were matched by sex and untreated plasma LDL cholesterol concentrations. The primary outcome was a composite of cardiovascular death, myocardial infarction, ischaemic stroke, percutaneous coronary intervention, coronary artery bypass grafting, aortic valve replacement, peripheral artery disease, carotid endarterectomy, angina pectoris, and supra-aortic or aortic stenosis (collectively referred to as atherosclerotic cardiovascular disease), for which survival analyses were performed in the matched cohort. Cox regression analyses were used to compare disease-free survival between cohorts and to calculate hazard ratio (HR) and 95% CI adjusted for sex, age at diagnosis, untreated plasma LDL cholesterol concentration, and number of lipid-lowering therapies other than lipoprotein apheresis.</p><p><strong>Findings: </strong>The overall cohort included 404 patients with a median age at diagnosis of 6·0 years (IQR 3·0-9·5) and median untreated plasma LDL cholesterol of 17·8 mmol/L (14·7-20·8). The matched cohorts included 250 patients (125 patients per group), with a median untreated LDL cholesterol of 17·2 mmol/L (14·8-19·7). Mean reduction in plasma LDL cholesterol concentrations between baseline and final follow-up was greater in the lipoprotein apheresis group (-55% [95% CI -60 to -51] vs -31% [-36 to -25]; p<0·0001). Patients in the lipoprotein apheresis group had longer atherosclerotic cardiovascular disease-free survival (adjusted HR 0·52 [95% CI 0·32-0·85]) and longer cardiovascular death-free survival (0·0301 [0·0021-0·4295]). Cardiovascular death was more common in the pharmacotherapy-only group than in the lipoprotein apheresis group (ten [8%] vs one [1%]; p=0·010), whereas median age at coronary artery bypass grafting was lower in the lipopro","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":"491-499"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140961259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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