Oregon Health & Science University
  • Laurie B. Armsby, M.D.Laurie B. Armsby, M.D.
    A pediatric cardiologist, Dr. Armsby is the director of the Pediatric Dyslipidemia Program at OHSU Doernbecher Children’s Hospital. For the last decade, her focus has been caring for children with high cholesterol.

Cholesterol screening for children is a sticky subject

Though the American Academy of Pediatrics recommends a fasting lipid panel for all children between 9-11 years old and 17-21 years old, debate remains about the usefulness of this information that requires a needle (never popular with kids or parents) to procure. Particularly for children who are within healthy parameters with no obvious risk factors, the screening may seem unnecessary to parents.

However, the prevalence of high cholesterol in children is on the rise in the United States. Among adults, high blood cholesterol levels have been proven to play a role in the development of premature coronary heart disease (CHD). And studies have shown that the atherosclerotic process can begin as early as 2 years of age in children with high cholesterol. Therefore, by identifying children with dyslipidemia, it may be possible to intervene early and prevent or delay CHD as they mature into adulthood.

In many cases, elevated cholesterol levels in children are a result of unhealthy lifestyles and diets leading to obesity, a significant concern across demographics. Without changing nutrition choices and fitness levels, this trend could have detrimental effects on cardiovascular health.

With inherited lipid disorders, the signs are often not obvious. About one in 500 adults have an elevated LDL cholesterol secondary to an inherited lipid disorder. Some studies show that the prevalence of inherited lipid disorders may actually be higher than previously thought. Unfortunately, many parents are not aware of their own cholesterol levels, so screening based on family history may fail to detect a significant number of children with familial hyperlipidemia. Uncovering this hidden risk at an early age is a mark in the plus column for universal screening.

Identifying inherited lipid disorders

Children who have an inherited lipid disorder are often an appropriate weight and physically active. The only indicator that may show risk is a known family history of early stroke or heart attack in parents or grandparents. Among these families, there is often already an elevated awareness of the importance of good health habits. This is beneficial for their overall cardiovascular profile, but unfortunately, in many cases has minimal impact on blood cholesterol levels. By verifying through screening whether a child has inherited the risk, families can make better choices by being informed of the potential impact and of the options for treatment.

Motivation through measurement

Having the screening data can be very helpful in motivating families to accept the need to make lifestyle changes and even to consider medication when recommended. For some families, avoiding the need for medication will be motivational. By seeing the patient’s data trends, whether showing improvement or worsening, parents can be inspired to sustain the changes they are making or reconciled to the necessity of initiating change.

Education to make often difficult changes

When a child with high cholesterol is referred to our clinic, we discuss all of the available information as well as the potential risks of therapy (or no therapy). Lifestyle changes can be challenging, particularly when factoring in varying levels of motivation and capacity for change among families.

Extensive discussions regarding nutrition and physical activity are important parts of these evaluations. If any supplement or medication therapy is recommended, parents will also want a thorough understanding of the implications.

The Pediatric Dyslipidemia Program at OHSU Doernbecher Children’s Hospital can assist with intervention

As the only pediatric program in the region specializing in pediatric dyslipidemia, OHSU Doernbecher Children’s Hospital has expertise in determining risk factors, level of intervention and education for all children with high cholesterol. The referral to a specialty program can underscore the seriousness of the concern, inspiring some openness to change. For children with hypertriglyceridemia and obesity, we can provide the ongoing support and motivation families need to make and sustain changes in diet and lifestyle with the assistance of staff dietitians and the Healthy Lifestyles Clinic.

For children with inherited conditions related to HDL and LDL, we are able to use our experience with similar cases to inform treatment and supervise statin medications, as well as educate the family fully on all available treatment options.

When to consult or refer

If a pediatric patient has one of the following lipid results, you may wish refer to the OHSU Doernbecher Pediatric Dyslipidemia Program for additional evaluation, education or treatment:

  • LDL ≥ 140mg/dL in child of any age
  • Triglycerides ≥ 200 mg/dL
  • HDL < 40 ± elevated TG

OHSU Doernbecher Children’s Hospital recommendations for childhood cholesterol screening

  • Perform a fasting lipid profile once between 9–11 years and again at 17–21 years.
  • If a fasting is challenging, measure a total cholesterol and HDL. For any that show elevated total cholesterol in the setting of a low HDL, request a fasting lipid panel.
  • If dyslipidemia is indicated by the fasting lipid panel, evaluate possible secondary dyslipidemias via a thorough
    history, a complete metabolic panel and thyroid function tests.
  • If hypertriglyceridemia is identified, nutrition counseling and lifestyle modification is indicated.
  • For elevated LDL levels, a risk assessment based on family history and the degree of elevation will determine whether nutrition counseling and lifestyle modification is sufficient or whether a statin therapy (<10 years) may be needed.
  • Low LDL results should be evaluated to rule out other metabolic abnormalities.

Risk factors for dyslipidemia in children

Physical risk factors include obesity, sedentary lifestyle, diabetes, hypertension, tobacco use, Kawasaki disease, solid organ transplant, cancer, HIV, hypertrophic cardiomyopathy, congenital heart disease, nephrotic syndrome, kidney disease, chronic inflammatory disease.

Family history risk factors include heart disease or stroke in a male parent or grandparent younger than 55 years old or female parent or grandparent younger than 65 years old. Parents or grandparents with a history of elevated cholesterol.

Download PDF of common dyslipidemia profiles in children

Contact us

OHSU Doernbecher Children’s Hospital specialists are always happy to consult with you. If you have questions or would like to refer a patient, please call the OHSU Physician Consult & Referral Service at 503-346-0644. Or to refer a patient, please send a fax to 503-346-0645.

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