Children between the ages of 9 and 11 should be screened

Mariah and Giselle Most of us are aware that high cholesterol is a health risk for adults, leading to a build-up of plaque in the arteries and a higher risk of heart disease.

But fewer of us know that the risks from high cholesterol can start in childhood. “Even young children may have high cholesterol,” explains Julie Brothers, MD, Director of the Lipid Heart Clinic at Children’s Hospital of Philadelphia.

Whether caused by genetic factors, poor nutrition or lack of exercise, high cholesterol in children is something to take seriously. Studies suggest that many young and middle-aged adults with heart disease may have had untreated cholesterol problems as children. And the incidence of high cholesterol in children is growing.

“The current guidelines recommend that all children have their cholesterol levels checked in a blood test between the ages of 9 and 11, and again when they are between 17 and 19,” says Dr. Brothers. “Children with special risk factors, including those with a family history of heart problems and children who are overweight, should have their levels tested earlier and more frequently.”

What is cholesterol

Cholesterol is a fat-like substance in the body. Most of it is produced in the liver, though some comes from the food we eat. The body needs some cholesterol. But when we have too much, health problems can begin to develop.

The medical term for abnormal cholesterol levels is “dyslipidemia.” When doctors check cholesterol, they measure the levels of three different types:

  • LDL cholesterol is the type that can clog blood vessels over time, and we want this level to be low.
  • HDL cholesterol works to carry cholesterol from the body to the liver, where it is broken down. High levels of HDL cholesterol are good for heart health.
  • Triglycerides are a type of fat carried in the blood and stored in fat cells. High levels of triglycerides are associated with fat build-up and weight gain.

Who is at risk?

“The most common reasons for high cholesterol are poor diet, being overweight, and not getting enough exercise,” says Dr. Brothers. “But some active and apparently healthy children inherit cholesterol problems from their parents. In fact, as many as 1 in 250 people have a genetic predisposition to high cholesterol, called familial hypercholesterolemia.”

Children with a family history of high cholesterol or early heart disease should have a complete fasting lipid profile as young as age 2. This includes children with a parent, grandparent, sibling, aunt or uncle who has high cholesterol or who has had a heart attack before age 55 for a man or before age 65 for a woman.

Children who are overweight or obese should also have their cholesterol levels routinely screened by their pediatrician.

The National Institutes of Health (NIH) and the American Academy of Pediatrics (AAP) recommend that all children, whether or not they have known risk factors, have their cholesterol levels checked once when they are between 9 and 11 years old, and again when they are between 17 and 19.

“The only way to know with certainty whether a child has high cholesterol is to perform a complete lipid profile using a blood test,” says Brothers.

What to do if a child has high cholesterol

If a lipid screening test shows that your child’s cholesterol is high, your doctor will recommend what actions to take.

“The first line of treatment is through changes in diet and increased physical activity,” says Brothers. “Children with high cholesterol who are overweight or obese usually respond well to these diet and lifestyle modifications.”

If diet and exercise don’t work to bring cholesterol levels down, your doctor may recommend treatment with statins, which are drugs to reduce cholesterol. “Studies have found statins to be safe and effective for children as young as 8 for certain genetic lipid disorders,” says Brothers. “But they must be used carefully. Once started, they are a lifetime commitment.”

Dr. Brothers has seen the benefits of early detection and treatment. “Lifestyle changes to manage high cholesterol in children can do more than reduce the risk of heart disease as adults. Healthy habits started young, like regular exercise and healthy eating, can have lasting benefits for life.”

Contributed by: Julie Brothers, MD

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