High cholesterol in children – What you need to know

Carissa M. Baker-Smith, MD, MPH, MS, FAHA, FAAP

Hypercholesterolemia, or higher than normal levels of “bad” cholesterol and total cholesterol, is a risk factor for premature coronary artery disease (CAD) – that can lead to a heart attack before 55 years of age in men and before 65 years of age in women. Our cholesterol levels are determined by what we eat but also by our body’s ability to clear cholesterol that is made in our bodies. Having a body mass index (BMI) greater than the 95th percentile (obesity) and diabetes are significant risk factors for the development of high cholesterol and for the development of premature CAD. More specifically, the more uncontrolled the diabetes, the worse the “bad” cholesterol can become, leading to hypercholesterolemia.

Another cause for high cholesterol is familial hyper-cholesterolemia (FH). FH is a genetic condition that is passed down through families and results in very high LDL (“bad” cholesterol) and total cholesterol levels, that can be in the thousands. This is due to a mutation in one of the genes that controls the way cholesterol is cleared by our bodies. In this condition, cholesterol accumulates in the blood and can build up in the walls of arteries, causing hardening or atherosclerosis.

It is recommended that all youth undergo a non-fasting lipid panel beginning at age 9- to 11- years. If there is a family history of FH; however, then screening should begin at 2- to 3- years of age. The diagnosis of FH is made based upon lipid panel testing and family history of premature CAD (before the age of 55 years in men and before the age of 65 years in women). FH should be suspected when the LDL cholesterol is above 190 mg/dl in adults and above 160 mg/dl in children without cholesterol-lowering medication. The diagnosis can also be confirmed with genetic testing. Early diagnosis is critical as this can be a life-threatening disorder that can lead to early heart attacks and strokes. It is also important that all family members of an affected individual are screened for the disease.

Even though lifestyle modifications and diet are important for heart health, for individuals with FH, diet alone is not effective. Youth with FH require treatment with cholesterol-lowering medications which can dramatically reduce the risks associated with the disease. Current recommendations for children with FH are to begin these medications around the age of 8.