Testing Recommended: High Cholesterol Can Occur in Childhood

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”.

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.

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.

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.

Hi Jen. Thanks for your question. We checked in with our cardiologist Dr. Sarah Henson about this. Here’s what she had to say:

The evidence that pediatric dyslipidemia contributes to atherosclerosis and the development of premature atherosclerotic cardiovascular disease supports the rationale for initiating lipid-lowering therapy during childhood/adolescence. The guidelines for cardiovascular health and risk reduction in pediatrics put out by the National Institutes of Health recommend the use of statins in kids with high LDL starting at the age of 10. Autopsy studies of healthy individuals killed in accidents or wars have shown that dyslipidemia in childhood is associated with increased risks of atherosclerotic lesion. Statin use in childhood has been shown to be safe and effective with no reported severe adverse effects. In a 20 year follow up of children with familial hypercholesterolemia (characterized by elevated LDL, and normal HDL and triglycerides) who were started on statins during childhood had lower rates of cardiovascular events in adulthood compared with their affected parents who were started on statins later in life. The use of lipid-lowering therapy in pediatric dyslipidemia is supported by the American Heart Association, the American Academy of Pediatrics, the National Lipid Association, the National Cholesterol Education Program, and an expert panel sponsored by the National Heart, Lung, and Blood Institute.