New KKH clinic for children suffering from genetic condition with high cholesterol levels (2024)

​KKH Lipid Centre is Singapore’s first dedicated clinic for the management of familial hypercholesterolaemia in children. PHOTO: LIANHE ZAOBAO

SINGAPORE – Thousands of children and adolescents who have a genetic condition that causes them to have high levels of bad cholesterol from a young age can seek targeted help at a new clinic in KK Women’s and Children’s Hospital (KKH).

KKH Lipid Centre is Singapore’s first dedicated clinic for the management of familial hypercholesterolaemia (FH) in children.

FH is an inherited disorder caused by mutations in genes involved in the metabolism of cholesterol. Affected children are born with dyslipidaemia, which is characterised by very high levels of low-density lipoprotein cholesterol (LDL-C) – better known as “bad cholesterol”.

This leads to the development of atherosclerosis, a build-up of fatty deposits that causes blockages and narrowing of the blood vessels and, subsequently, cardiovascular diseases, said KKH.

The centre – which is part of the metabolic health programme under the KKH-led SingHealth Duke-NUS Maternal and Child Health Research Institute (MCHRI) – will aim to proactively identify and manage FH in early childhood.

In managing children diagnosed with the disease, the centre will focus on “individual characteristics and genomics” to administer therapy at the right time for each affected patient.

“Unlike FH in adults which can be managed by statins and lipid-lowering drugs, FH in childhood can manifest more severely, and require targeted diagnosis and aggressive treatment,” said Professor Fabian Yap, deputy director at MCHRI.

According to a 2022 study, about 35,000 people in Singapore, or one in 140, suffer from FH. These include 4,000 children and adolescents, said KKH in a statement on May 20.

Despite this figure, more than 90 per cent of FH cases in Singapore remain undiagnosed or do not receive timely treatment, especially among children and adolescents.

Prof Yap, who is also head and senior consultant of endocrinology service at KKH, said: “Of greater concern is the fact that FH in childhood can also be insidious and stay silent until cholesterol levels are actually measured. Being genetic, FH cannot be addressed by dietary and lifestyle changes alone.”

He added: “As the risk of atherosclerosis is cumulative and starts early in life, early detection for children at risk of this genetic condition is crucial. For instance, the first two years of life are key to the diagnosis of hom*ozygous FH, a more severe form of FH which is inherited from both parents.”

Children with untreated FH have LDL-C levels of over 4.1 millimoles per litre (mmol/L) and can show no symptoms as effects of heart complications from impaired blood vessel linings build up over time. In comparison, the optimal LDL-C for children aged two to 18 is less than 3.5 mmol/L, KKH noted.

The centre encourages early screening for children at risk of FH to prevent lifelong cholesterol build-up and related diseases. They include children whose immediate family members are already diagnosed with FH or have a history of developing cardiovascular disease earlier in life – before 65 years for women, and before 55 years for men.

A child’s diagnosis can play an important role as it can lead to identifying and treating an affected parent or other family members. FH in adulthood carries a 50 per cent chance of being passed down to the next generation.

“Individuals with FH are potential time bombs, unaware of their condition until it manifests into serious health issues. For those affected by dyslipidaemia, this can be addressed with early screening and intervention. These are also the first steps towards realising a future of a population free from cardiovascular disease,” said Prof Yap.

While FH is genetic, non-genetic forms of dyslipidaemia exist, notably in lifestyle-linked obesity.

According to the NCD Risk Factor Collaboration health science network, South-east Asia is the new global epicentre of dyslipidaemia largely linked to obesity, KKH said.

In Singapore, obesity is on the rise among school-going children, up from 13 per cent in 2017 to 16 per cent in 2021.

The centre will develop guidelines to support paediatricians and primary healthcare practitioners to manage dyslipidaemia in obese children, said KKH, through lifestyle adaptations with diet, physical activity and healthy choices.

Appointments for screening can be made on this page.

Correction note: An earlier version of this article stated that children at risk of familial hypercholesterolaemia (FH), include children whose immediate family members are already diagnosed with FH or have a history of developing cardiovascular disease earlier in life – before 55 years for women, and before 65 years for men. KK Women’s and Children’s Hospital has since said it should be 65 years for women and 55 years for men.