Cholesterol & Triglycerides in Children

Thomas Higgins, MD
Nanci Grayson, MS, RD, CDE

Artheroscleosis has its roots in childhood. Atherosclerotic plaques are commonly seen at autopsy in accident victims as early as 10 years of age. In rare cases of Homozygous Familial Hypercholesterolemia, atherosclerosis can occur much earlier. The earliest documented heart attack & death in such a patient was at 4 years of age.

At the present time, routine screening of children for lipid problems is not recommended. On the other hand, lipid screening should be undertaken in those children who have risk factors such as obesity or a strong family history of atherosclerosis. The current recommendations for lipid levels in children less than 21 years of age include:

Over 21 years of age, adult recommendations & treatments should be followed. The reader is referred to the companion article in this series on cholesterol & triglycerides.

Treatment recommendations for children involve lifestyle changes to improve dietary habits and to increase physical activity. Lifestyle changes are the primary intervention in all patients and are necessary for additional therapy to be effective. Dietary recommendations for children are unique to the child's age, size & level of physical activity. It is important to support the nutritional needs for growth and development while managing any lipid problems which may be present. Children are not simply small adults. Please see our dietary page for further recommendations concerning the nutritional requirements for children.

When diet and exercise fail to improve lipid into acceptable ranges, drugs may become necessary. There is a reasonable concern over beginning drugs in growing children, especially when these need to be continued life long. Drug therapy is generally reserved for children over 10 years of age since this is the age where new atherosclerotic lesions are commonly seen. Bile acid sequestering agents & niacin are considered the first line of drug therapy. In most practices, it is very difficult to get children to take these medications because of their side effects. Other drug therapy options are statins & fibric acid derivatives. These are both well tolerated by children. Treatment prior to 10 years of age should be considered in severe cases. The most severe patients have Familial Hypercholesterolemia. They often respond poorly to statins and other drugs. These patients may require repeated plasmapharesis and occasionally liver transplantation for lipid control.