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Heart Center

Heart Conditions in Children - Cholesterol, LDL, HDL, Triglycerides

Facts about cholesterol:

Cholesterol is a waxy substance that can be found in all parts of your child's body. It aids in the production of cell membranes, some hormones, and vitamin D. The cholesterol in blood comes from two sources: the foods your child eats and his/her liver. However, your child's liver makes all of the cholesterol your child's body needs.

Cholesterol and other fats are transported through the blood stream in the form of round particles called lipoproteins. The two most commonly known lipoproteins are low-density lipoproteins (LDL) and high-density lipoproteins (HDL).

What is LDL (low-density lipoprotein) cholesterol? What is HDL (high-density lipoprotein) cholesterol?

This type of cholesterol is commonly called "bad" cholesterol. It can contribute to the formation of plaque build up in the arteries, known as atherosclerosis.

LDL levels should be low. To help lower LDL levels, help your child to:

  • avoid foods high in saturated fat, dietary cholesterol, and excess calories.
  • increase exercise.
  • maintain a healthy weight.

This type of cholesterol is known as "good" cholesterol, and is a type of fat in the blood that helps to remove cholesterol from the blood, preventing the fatty build up and formation of plaque.

HDL should be as high as possible. It is often possible to raise HDL by:

  • exercising for at least 20 minutes three times a week.
  • avoiding saturated fat intake.
  • decreasing body weight.

For some children, medication may be needed. Because raising HDL can be complicated, you should work with your child's physician on developing a therapeutic plan.

Checking blood cholesterol levels:

A cholesterol screening is an overall look at, or profile of, the fats in the blood.

Physicians in the past felt that children were at little risk for developing high cholesterol levels and other risk factors for heart diseases affecting the coronary arteries and blood vessels until later in life. However, many physicians now realize that children are increasingly at risk for having high blood cholesterol levels as a result of one, or more of the following:

  • sedentary lifestyles (playing video games and watching TV instead of participating in vigorous exercise)
  • high-fat junk food and fast-food diets
  • obesity
  • family history of high cholesterol levels

Children and adolescents with high cholesterol are at higher risk for developing heart disease as adults. Many physicians are recognizing that keeping blood cholesterol levels in normal ranges throughout one's lifetime may be of great benefit in reducing the likelihood of developing coronary artery disease and high blood pressure.

Cholesterol testing for children:

The National Heart, Lung, and Blood Institute (NHLBI), a division of the National Institutes of Health, recommends that cholesterol testing begin at age 2 for any child who has the following:

  • at least one parent who has been found to have high blood cholesterol (240 milligrams or greater)
  • a family history of early heart disease (before age 55 in a parent or grandparent)

The NHLBI also recommends that children who have demonstrated risk factors, such as obesity, should have cholesterol and other lipids tested periodically by their physicians.

In 2008, the American Academy of Pediatrics (AAP) published updated guidelines that added more specific recommendations to those above, including testing of children older than 2 years whose family health history is unknown. The AAP also recommends that physicians should consider giving cholesterol-lowering medications (statins) to children more than 8 years old who have high LDL blood levels.

A full lipid profile shows the actual levels of each type of fat in the blood: LDL, HDL, triglycerides, and others. Consult your child's physician regarding the timeliness of this test.

What is a healthy blood cholesterol level?

Blood cholesterol is very specific to each individual. A full lipid profile can be an important part of your child's medical history, and important information for your child's physician to have. In general, healthy levels are as follows:

  • LDL - less than 130 milligrams (mg)
  • HDL - greater than 35 mg (less than 35 mg puts your child at higher risk for heart disease)

The NHLBI recommends the following guidelines for cholesterol levels in children and teenagers (ages 2 to 19) from families with high blood cholesterol or early heart disease:

  Total cholesterol LDL cholesterol
Acceptable Less than 170 mg Less than 110 mg
Borderline 170 to 199 mg 110 to 129 mg
High 200 mg or greater 130 mg or greater

What treatments are available for high cholesterol?

Medical treatment may include:

  • modification of risk factors - risk factors that can be changed include lack of exercise and poor dietary habits.
  • cholesterol lowering medications - medications used to lower lipids (fats) in the blood, particularly Low Density Lipid (LDL) cholesterol. Statins are a group of antihyperlipidemic medications, and include simvastatin (Zocor®), atorvastatin (Lipitor®), and pravastatin (Pravachol®), among others. Bile acid sequestrants - colesevelam, cholestyramine and colestipol - and nicotinic acid (niacin) are two other types of medications that may be used to reduce cholesterol levels.

Statistics about cholesterol:

Elevated cholesterol is a risk for many Americans. Consider these statistics:

  • About 98.6 million American adults have total blood cholesterol levels of 200 mg/dl and higher, and of those about 34.4 million American adults have level of 240 or above.
  • Elevated cholesterol levels early in life may play a role in the development of adult atherosclerosis.
  • According to the American Heart Association, high blood cholesterol that runs in families will affect the future of an unknown (but probably large) number of children.

What are triglycerides?

Triglycerides are another class of fat found in the bloodstream. The bulk of your child's body fat tissue is in the form of triglycerides.

The link between triglycerides and heart disease is under clinical investigation. However, many children with high triglyceride levels also have other risk factors such as high LDL levels or low HDL levels.

What causes elevated triglyceride levels?

Elevated triglyceride levels may be caused by medical conditions such as diabetes, hypothyroidism, kidney disease, or liver disease. Dietary causes of elevated triglyceride levels may include obesity and high intakes of fat, alcohol, and concentrated sweets.

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