Pediatric hypercholesterolemia refers to elevated levels of cholesterol in a child’s blood. While often without immediate symptoms, this condition warrants attention as it can lead to health challenges later in life. Addressing high cholesterol in children promotes long-term well-being.
Understanding High Cholesterol in Children
Cholesterol is a waxy, fat-like substance found throughout the body. It plays a role in building cell membranes, producing hormones, and aiding brain development. The body produces cholesterol in the liver, and it also comes from foods consumed. Cholesterol and other fats, known as lipids, travel through the bloodstream in particles called lipoproteins.
Different types of cholesterol include low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides. LDL cholesterol is often called “bad” cholesterol because high levels can lead to plaque buildup in arteries, a process known as atherosclerosis. HDL cholesterol is considered “good” cholesterol because it helps remove excess cholesterol from the blood and transport it back to the liver for removal from the body, helping to prevent plaque formation. Triglycerides are another type of fat in the blood, and high levels are also linked to an increased risk of heart disease. In children, high cholesterol levels are concerning because they can contribute to the early development of atherosclerosis, increasing the risk for future cardiovascular disease, heart attacks, and strokes as they reach adulthood.
Causes and Risk Factors
Pediatric hypercholesterolemia can stem from a combination of genetic predispositions and lifestyle factors. One significant genetic cause is Familial Hypercholesterolemia (FH). This inherited condition results in very high levels of LDL cholesterol from birth because the liver struggles to clear it from the blood. FH is typically inherited in an autosomal dominant pattern, meaning a child has a 50% chance of inheriting the condition if one parent is affected. Individuals who inherit one abnormal gene (heterozygous FH) may develop cardiovascular disease prematurely, often by ages 30 to 40, while those inheriting two abnormal copies (homozygous FH) can experience severe cardiovascular disease in childhood.
Lifestyle factors also contribute to elevated cholesterol levels in children. Diets high in saturated and trans fats can lead to increased cholesterol. A lack of physical activity and obesity are additional risk factors, as they can negatively impact lipid profiles. Furthermore, certain underlying medical conditions can cause high cholesterol, including Type 2 Diabetes Mellitus, hypothyroidism, and kidney or liver diseases.
Identifying the Condition
Pediatric hypercholesterolemia is typically diagnosed through cholesterol screening. The National Heart, Lung, and Blood Institute (NHLBI) and the American Academy of Pediatrics (AAP) recommend universal cholesterol screening for all children between the ages of 9 and 11 years, and again between 17 and 21 years. Targeted screening may be recommended earlier, as early as age 2, for children with specific risk factors, such as a family history of high cholesterol, early heart disease, high blood pressure, diabetes, or obesity.
The diagnostic process involves a blood test, specifically a fasting lipid panel, though a non-fasting test may be used for initial universal screening. For a fasting lipid panel, a child should not eat or drink anything but water for 10 to 12 hours before the test. This panel measures total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. If non-fasting results are abnormal or borderline, a fasting lipid panel is often recommended for a more accurate assessment.
In children, an acceptable total cholesterol level is generally less than 170 mg/dL, with borderline levels between 170-199 mg/dL and high levels at 200 mg/dL or greater. For LDL cholesterol, less than 110 mg/dL is considered acceptable, 110-129 mg/dL is borderline, and 130 mg/dL or greater is high. HDL cholesterol should ideally be greater than 45 mg/dL, while triglycerides should be less than 75 mg/dL for children under 10 years old and less than 90 mg/dL for those aged 10-19 years.
Management Approaches
Managing high cholesterol in children primarily focuses on lifestyle modifications, which serve as the first line of treatment. Dietary changes are a key component, emphasizing a reduction in saturated and trans fats. This involves choosing lean proteins like fish, skinless poultry, and lean cuts of meat, and opting for low-fat or fat-free dairy products for children over two years old. Increasing the intake of fruits, vegetables, whole grains, and legumes is also recommended, as these foods are high in fiber and can help lower cholesterol levels. Limiting added sugars, processed foods, and sugary drinks is also advised.
Alongside dietary adjustments, regular physical activity plays an important role. Children aged 6 to 17 years should aim for at least 60 minutes of moderate-to-vigorous physical activity daily, which can help increase HDL (“good”) cholesterol levels and reduce cardiovascular risk. Weight management is also a focus, particularly for children who are overweight or obese, as losing excess weight can improve cholesterol and triglyceride levels.
If lifestyle changes are insufficient after a period of 3 to 6 months, or in cases of severe hypercholesterolemia, medication may be considered. Statins are the most commonly prescribed medications, approved for use in some children as young as 8 years old, and others at age 10 and older, especially when LDL cholesterol levels remain persistently high (e.g., above 190 mg/dL, or above 160 mg/dL with other risk factors). These medications are typically initiated under strict medical supervision and monitored regularly.
Preventing Future Health Issues
Untreated high cholesterol in childhood can have significant long-term implications. The process of atherosclerosis, a buildup of fatty plaque in blood vessel walls, can begin early in life. This increases the risk of cardiovascular disease, heart attacks, and strokes in adulthood. Early intervention and management of pediatric hypercholesterolemia can significantly reduce these future health risks, leading to a reduced risk of cardiovascular events and mortality later in life.
Ongoing monitoring with healthcare providers is important to track cholesterol levels and adjust management strategies as needed. This often involves regular blood tests to ensure lipid levels are within healthy ranges. Reinforcing healthy lifestyle habits across the entire family can also be beneficial. A family-wide commitment to a balanced diet, regular physical activity, and maintaining a healthy weight not only supports the child with high cholesterol but also helps prevent the condition in other family members and promotes overall well-being for everyone.