BLOOD CHOLESTEROL LEVELS IN CHILDREN AND ADOLESCENTS

High blood cholesterol levels clearly play a role in the development of premature coronary heart disease in adults, and it has also been shown that lowering blood cholesterol levels in adults results in a significant decrease in coronary heart disease rates and mortality. No long-term studies have been conducted showing the relationship of blood cholesterol levels measured in childhood to coronary heart disease in later life. However that relationship can be inferred based on these facts: 1. Compared with their counterparts in other countries, US children have higher cholesterol levels and higher intakes of saturated fatty acids and cholesterol, and US adults have higher rates of coronary heart disease. 2. Autopsy studies demonstrate that early coronary atherosclerosis often begin in childhood and are related to high cholesterol. 3. Children and adolescents with elevated serum cholesterol levels, particularly LDL-cholesterol levels, often come from families with elevated values and in which there is a high incidence of coronary heart disease.

Selective Screening is preferred to screening all children. Children and adolescents who are recommended for selective screening in the context of regular health care are: 1. Children and adolescents whose parents or grandparents, at <55 years of age, were found to have coronary atherosclerosis, or had a documented myocardial infarction, cerebrovascular disease, or sudden cardiac death. 2. The offspring of a parent with an elevated blood cholesterol level (240 mg/dL or higher). 3. Children and adolescents whom the physician may feel have a higher chance of having an elevated cholesterol. For example, adolescents who smoke, consume excessive amounts of saturated fats and cholesterol, or are overweight may also be tested at the discretion of their physician.

The "normal" value of Cholesterol, LDL, and HDL is based on population studies and the incidences of vascular disease. To remember which is good or bad, think of the "L" standing for lousy and the "H" stands for happy. It would appear that the lower the Cholesterol, the lower the LDL, and the higher the HDL, there is less rate of disease. Any improvement in the child’s blood values will increase their health and life span. The values that the American Academy of Pediatrics have published are to have the cholesterol below 170, and the LDL below 110. The lower the better.

The effort to lower the cholesterol is mainly through diet and medications. Exercise is also important. Children below 2 years of age should not be tested nor treated The recommendations for the diet of the general population of children are these. 1) Nutritional adequacy should be achieved by eating a wide variety of foods; 2) Caloric intake should be adequate to support growth and development and to reach or maintain desirable body weight. 3) Saturated fatty acids <10% of total calories; 4) Total fat over several days of between 20% and 30% of total calories; and 5) Dietary cholesterol <300 mg per day. It is interesting that pepperoni pizza is 44% and chicken nuggets are 60% fat calories. Most school lunches are now within these guidelines. Studies have shown that educating the children in school classes as to the benefits of a proper diet will help the children to cooperate with these diet policies set by the patents and schools. Check your school’s meals and see that they have classes on this during the year.

Routine testing of children starts during teens. Younger children only if family history indicates it. Drug therapy is usually considered for children >10 years of age after an adequate trial of diet therapy for 6 to 12 months. Children between 5 and 10 yr. old may be treated if their cholesterol is extreme: >300. There are several recommended medications for the treatment of hypercholesterolemia and high LDL levels in children and adults. These newer medications are safe and do not affect the child’s growth and development. Your physician will advise you on when to treat and which medication is proper for your child.

Studies show that if the cholesterol is decreased to near 150-160, the advancement of artery plaques is stopped and clinical heart and stroke incidence decreases dramatically. There are very nice medications with almost no side effects that can prolong or save your life. Please see you doctor about testing the adults as well as the teens in the family.

Because over half of the "healthy" twenty year olds who were killed in war were shown to have many of their coronary arteries already more than 50% occluded, we have learned that heart disease is a life long problem. Waiting until one is 50 years old to take care of your heart is too late. Proper diet and exercise learned at a young age will carry over into a healthier teenager and adult.