Children May Have Cholesterol Problems, Too

High cholesterol levels are not just found in adults. Children may have high cholesterol, too, even without being overweight. Over years, cholesterol overload has similar hazards as in adults -- clogged arteries and injury to the heart.

The Children's Hospital of Philadelphia recommends that children, starting at age two years, should have a complete cholesterol profile checked after an overnight fasting if they have a family history of high cholesterol or of early heart disease, in line with similar recommendations from the American Academy of Pediatrics and the American Heart Association. Those who do not have a family history but have other risk factors for early heart disease, such as being overweight, high blood pressure, diabetes, smoking, poor diet, and sedentary lifestyle should also be screened.

"Although the most common reasons for high cholesterol are poor diet, being overweight, and not getting enough exercise, some apparently healthy children inherit high cholesterol levels from their parents," said Julie Brothers, M.D., medical director of the Lipid Heart Clinic at The Children's Hospital of Philadelphia. "Overall, we've noticed an increase in children's cholesterol levels the past several years and this is a disturbing trend."

Children with a family history of high cholesterol or early heart disease, even if they have normal weight, should be routinely screened, as they may have a genetic predisposition for excess cholesterol levels -- familial hypercholesterolemia (FH). These children have high levels of low-density lipoprotein (LDL), also called "bad cholesterol," beginning at birth, which can lead to early thickening of the artery walls, premature cardiovascular disease and an increased risk of early heart attack.

Familial hypercholesterolemia is underestimated in the community and in pediatric primary care practices. Children with FH have no symptoms or signs of their condition and often do not fit the profile of someone who is at risk; they usually have a normal weight and a healthy lifestyle and diet. However, in addition to a family history of high cholesterol, they usually have a family history of early heart disease. Children with a parent, grandparent, sibling, aunt, or uncle with high cholesterol or who has suffered a cardiac event before the age of 55 should be routinely monitored.

Children who are overweight or obese should also have their cholesterol levels routinely screened by pediatric healthcare professionals, as this also places them at increased risk of developing early heart disease.

It is important to differentiate between obese children with high cholesterol and those with FH, which is not traditionally associated with obesity; however, with the obesity epidemic, many children with FH now also are overweight or obese.

"Cholesterol levels in children who are obese usually respond well to diet and lifestyle modifications, whereas children with FH often need medications in addition to diet and exercise," added Dr. Brothers.

Modifications to diet and increased physical activity are the first-line treatments for children identified with raised cholesterol levels. Another option is putting a child on statin therapy, which is a lifetime commitment.

The Lipid Heart Clinic at The Children's Hospital of Philadelphia evaluates and treats children and adolescents who have high levels of lipids (fats) in their blood. Elevated lipids put young people at risk for heart disease later in life.