Testing Recommended: High Cholesterol Can Occur in Childhood - Cincinnati Children's Blog

Testing Recommended: High Cholesterol Can Occur in Childhood

High cholesterol isn’t a problem limited to adulthood. In fact, it’s becoming more common in children. The Centers for Disease Control and Prevention reports that among youths aged 12-19 years, 14% of kids who are normal weight and 43% of children who are obese have at least one abnormal cholesterol level.

The alarming aspect of those numbers is that typically kids with high cholesterol move on to become adults with high cholesterol, which may eventually lead to heart disease.

That’s why the American Academy of Pediatrics (AAP) recently announced new guidelines for when children should have their cholesterol levels checked, as a part of other updates for well-child visits. Their aim is for early prevention:

All children, regardless of risk or family history, should have their cholesterol checked between ages 9-11.

Previously the AAP did not have formal guidelines associated with the timing of testing for the general pediatric population, choosing instead only to test those children with risk factors, such as obesity, diabetes, or family history. The problem with this initial philosophy for children, and one of the reasons for the change, is that high cholesterol is usually a silent condition. It can happen with or without the presence of obesity, diabetes, or family history.

The young age range for when children should be tested may be surprising for some parents, but studies have shown that the negative effects of high cholesterol in children may occur early in life and without screening the general population, those children at-risk remain undetected.

Even if your child doesn’t have high cholesterol, which is the ideal scenario, it’s helpful for your pediatrician to have a baseline level before your child goes through puberty. The choice of age range 9-11 is based primarily on the potential to intervene more effectively if an abnormality is detected in this age group relative to younger children.

Early testing means early prevention. If we can catch children with high cholesterol early, we have a better chance of helping them to reverse the negative consequences associated with the disease. Too much cholesterol can lead to a buildup of plaque on the walls of the arteries that transport blood to the heart and other organs. When this happens, arteries can become narrowed and blocked.

The good news is that early prevention in children can lead to better chances for reversal of the disease. And relatively speaking it is easier to change the habits of a 10-year-old than that of an adult.

So what do those interventions look like? Typically in our lipid clinic we recommend lifestyle changes such as diet and exercise to help decrease high cholesterol levels.

Here are some general recommendations we give our patients for maintaining a healthy diet and lowering their cholesterol:

  1. Read food labels carefully
  2. Limit dietary fat to less than 25% of total daily calories (in particular, reduced saturated fats to less than 10% of daily calories)
  3. Limit cholesterol to less than 300 mg per day
  4. Choose nonfat or low-fat milk and dairy products
  5. Increase intake of fruits, vegetables, and whole grains
  6. Limit screen time to two hours or less per day (including gaming devices and computers)
  7. Be active for 60 minutes every day

If your pediatrician does not mention cholesterol testing for your child at his next well-child visit, and your child is between the ages of 9-11, I recommend you bring it up. Checking cholesterol levels in this age range is an important step to ensure that children are on the right track for a healthy heart later in life.

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Dr. Nicolas Madsen

About the Author: Dr. Nicolas Madsen

Nicolas Madsen, MD, is a cardiologist at Cincinnati Children’s Heart Institute, with special interest in the prevention of cardiovascular disease. He is focused on research and community outreach programs to find better ways to screen and educate children and adolescents regarding their risks for heart disease or sudden cardiac arrest.

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  1. Sanu March 13, 13:11
    Hi, I have a question about the levels, is there is a borderline level which is specific for kids at that age. Thanks.
    • Dr. Nicolas Madsen
      Dr. Nicolas Madsen Author March 13, 16:38
      Great question. As with all testing results, there are some levels which are borderline. The exact nature of what constitutes "borderline" is dependent on the child's personal and family history regarding risk factors. For example, the "bad" cholesterol, known as LDL, should be less than 130 mg/dL in children to fall into a level that is considered normal. However, it is not recommended to initiate treatment until the level rises to above 190 mg/dL in the general population or above 160 mg/dL in the at risk population. Thus, levels of 130-160 are "borderline".
  2. Belinda c. January 03, 20:05
    Almost thirty years ago, I was diagnosed with high cholesterol (360), hereditary, as I was neither obese nor led an unhealthy lifestyle. I was 13 or 14 years old, and had a routine cholesterol check with a physical for varsity level sports. I received care through a clinical trial at John Hopkins University for at most 2 years. The experience led me to develop first an aversion to food, and later an eating disorder. I did not do anything for the cholesterol until I reached my mid-thirties, and had two children. While the tips that you offer above are all reasonable for anyone to follow, the reality is that when you have high cholesterol as a child, medicating is nearly always the method of treatment in the eyes of a physician. At the time of my diagnosis, I was a young girl, and felt that the medicine was mainly used and tested on 50+ yr old men. It was a crapshoot whether or not the side effects of long term use would outweigh the benefits of a lifetime of use. Unfortunately, I don't believe that this has changed in the thirty years, and I agonize over having my children tested. To date, I have refused, because I know that if they do test positive, there appears to be only one method of treatment. I wonder if you have a reason for not mentioning medication as an intervention....
    • Dr. Nicolas Madsen
      Dr. Nicolas Madsen Author January 12, 09:03
      Belinda: Thanks so much for your question. You certainly point out some of the real problems with the question of high cholesterol levels in children and young adults, and as you accurately point out, some of these questions are longstanding. While I understand your hesitation, I would encourage you to have your children screened given the potential for you to have passed on the genes for elevated cholesterol to them. I think the answer to the question of what to do if the levels are elevated is evolving. As you have read, I strongly advocate maximizing lifestyle interventions as a first response to the discovery of elevated cholesterol. However, as you mention, this approach can have limitations in certain people with a strong genetic predisposition to high cholesterol. At that point, many physicians will turn to medications given what we know about the longterm negative health effects of cholesterol. This approach is largely based on the huge number of studies from the adult medicine community. But what about medications for children - what I can tell you is that there are ongoing studies to understand the impact of cholesterol medications on children and young adults (both positive and negative). While these studies do not follow their subjects for many decades, they do allow the medical community to understand the impact of (for example) 3-5 years of statin therapy on a teenager. As you point out, there is a lot to learn and for that reason there are many people deeply invested in this question. I am sure that our options will only improve over time. Hope that helps.
  3. Goldilocs March 02, 00:42
    I have genetically high cholesterol combined number 333 and I am not on a statin drug .( I am under the watchful eye of a cardiologist). They have recently changed the guidelines I took a test called a VAP test which is more accurate in determining ones risk for cardiovascular disease. Some people do need statin drugs but there are a lot of variables to consider. Remember there are risks associated with statin drugs and in some people the benefits do not out way the risks. I am not advocating going off statin drugs without talking to your Dr. But we must educate ourselves.
  4. cheryl September 19, 18:18
    how high is too high for children with lp(a)? Are you treating children with high lp(a)?
    • Dr. Nicolas Madsen
      Dr. Nicolas Madsen Author September 21, 12:20
      Cheryl - this is a great question and one that will likely have a different answer in the years to come as we learn more. For a quick review of your question for readers who may not be familiar with lipoprotein A, also known as Lp(a): Lp(a) is carried on the LDL particle (the so-called "bad" cholesterol). The level of Lp(a) in the body appears to be very much related to the genetics of a person. In fact, there are not truly any medications that specifically and effectively target Lp(a). However, because of the binding to LDL, the common practice is to treat LDL as a surrogate because the less LDL there is to bind to, the lower the risk imposed by Lp(a). The most common medication used in this way is a Statin. Currently, my practice in pediatrics is to not check Lp(a) as part of my screening efforts. This is largely because it is not presently understood how high is too high in the pediatric age range and as mentioned above, there are not any medical trials that have demonstrated a method for predictably lowering Lp(a) in kids. About the only circumstance when I might consider checking Lp(a) would be in a child who has had an otherwise unexplained stroke (which thankfully is very rare), and even in this case, my focus will still be to manage the LDL as the best way to reduce risk of further cardiovascular disease. My guess is that as we learn more, my practice and management of Lp(a) will change, but until then, I would recommend remaining focused on LDL levels in kids (for all the reasons highlighted above). I hope that helps.
  5. Jix June 28, 02:26
    My son was diagnosed with high triglyceride level at the age of 2, doctors we consulted recommended for a dietary change and some omega-3 tabs which helped in reducing the triglyceride levels by few points, there after past 5yrs we are doing frequent lipid level check to monitor the levels however it always remained at very high, now my son is 8yrs old and recent lipid test results are Tg 2337, HDL 9.3, LDL 3.56 Total Cholesterol 293 mg/dl. My question is are there any other check that needs to be done for determining ones risk for cardiovascular disease? and what is the recommended age for starting medications?
    • Dr. Nicolas Madsen
      Dr. Nicolas Madsen Author July 03, 12:35
      Hi Jix, I would recommend that your son is put in touch with a pediatric preventive specialist. As you point out, that is a very high TG level. Have you reached out to specialists in pediatric lipid management? Your son’s case is outside the usual for children his age. Hopefully you live in an area with some local expertise. The typical age to initiate medications is 10 years of age. Hope that helps.