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HOME/Childhood Obesity/Testing Recommended: High Cholesterol Can Occur in Childhood

Testing Recommended: High Cholesterol Can Occur in Childhood

Testing Recommended: High Cholesterol Can Occur in Childhood
August 25, 2022
11 Comments
By: Sarah Henson, MD

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 are more likely to have high cholesterol as adults, putting them at higher risk for heart disease. 

The American Academy of Pediatrics (AAP) recommends that all children, regardless of risk or family history, have their cholesterol checked between ages 9-11.

WHY SO YOUNG?

The young age range for when children should be tested might surprise some parents, but high cholesterol is usually a silent condition. It can happen with or without the presence of obesity, diabetes or family history. Studies have shown that the negative effects of high cholesterol in children may occur early in life. 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

Identifying high cholesterol in childhood leads to earlier interventions aimed at preventing atherosclerotic cardiovascular disease (hardening of the arteries) and reversing any changes that have already occurred. 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 these buildups take decades to occur, but atherosclerotic changes begin in childhood. In addition, they speed up when someone also has other conditions such as dyslipidemia, obesity, hypertension and diabetes. Early prevention in children can lead to better chances for reversing these early changes and decreasing the risk of cardiovascular disease in adulthood. Establishing healthy diet and exercise habits in childhood gives kids the best chance to be healthy active adults. 

HOW TO DECREASE HIGH CHOLESTEROL IN KIDS

So what do those interventions look like? Typically in our lipid clinic we recommend lifestyle changes including 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 cholesterol:

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

If your pediatrician does not mention cholesterol testing for your child at their 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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TAGS:
  • heart disease
  • obesity
  • tween health
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About the author: Sarah Henson, MD

Sarah E. Henson, MD, received her medical degree at the University of Arkansas and completed her pediatric residency at the University of Oklahoma Health Sciences Center. She completed a Pediatric Cardiology Fellowship and Advanced Pediatric Preventive Cardiology Fellowship at Cincinnati Children’s Hospital Medical Center. Dr. Henson’s advanced training in the diagnosis and treatment of high cholesterol and high blood pressure makes her a great addition to our Preventive Cardiology team.

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Comments

Sanu March 13, 2014 at 1:11 pm

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 March 13, 2014 at 4:38 pm

    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 c. January 3, 2015 at 8:05 pm

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 January 12, 2015 at 9:03 am

    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.

Goldilocs March 2, 2015 at 12:42 am

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.

cheryl September 19, 2016 at 6:18 pm

how high is too high for children with lp(a)? Are you treating children with high lp(a)?

    Dr. Nicolas Madsen September 21, 2016 at 12:20 pm

    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.

Jix June 28, 2017 at 2:26 am

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 July 3, 2017 at 12:35 pm

    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.

Jen June 25, 2022 at 2:54 am

Hello, I was wondering if there have been any updates on the discussion of medication interventions in young kids with high cholesterol. Mine most likely have familial dyslipidemia, but I don’t see the point of starting them on medicine now before puberty. They have high LDL, normal HDL, and low Triglycerides. Does that profile make any difference in management? Thank you.

    Social Media Team June 28, 2022 at 9:42 am

    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.

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