Pediatric hypercholesterolemia (high cholesterol)

What is pediatric hypercholesterolemia (high cholesterol)?

Cholesterol is a waxy, fat-like substance. It is essential to building cells and making some vitamins and hormones. High cholesterol (hypercholesterolemia) means high levels of a low-density lipoprotein cholesterol, commonly called LDL. High cholesterol in children is linked to early onset atherosclerosis and future cardiovascular disease.

What are the different types of cholesterol?

• Low-density lipoproteins (LDL) - Know as the "bad cholesterol," LDL leads to fatty deposits in the arteries and causes atherosclerosis. The result can be serious complications like heart attack, strokes and early severe diseases.

• High-density lipoproteins (HDL) - HDL is the “good cholesterol” as it carries the LDL cholesterol away from the arteries and back to the liver for elimination from the body. A healthy HDL level protects against heart attacks and strokes.

• Triglycerides are fat-like substances in the body that store excess energy from the diet. They are often measured with other cholesterol levels.

What are the signs and symptoms of pediatric hypercholesterolemia (high cholesterol)?

High cholesterol typically doesn’t cause any symptoms until your child has a serious event, such as a stroke or heart disease. If you or other family members have high cholesterol, you should have your child's cholesterol levels checked too.

High cholesterol that is passed on in families (called familial hypercholesterolemia) often results in extremely high levels of LDL due to a gene mutation that clears cholesterol from the blood. There is a 50% chance for a child to inherit the disorder from an affected parent.

How is pediatric hypercholesterolemia (high cholesterol) diagnoised?

Lipid screening in children ages 9-11 and 17-21 years helps diagnose high cholesterol. In some cases, two additional fasting lipid tests will be taken two weeks to three months apart.

Your child’s doctor will ask about family history and dietary habits. The doctor may order blood tests to rule out various conditions that can cause high cholesterol. If there is a family history of high cholesterol, genetic testing can determine if your child has inherited familial hypercholesterolemia.

What are the causes of pediatric hypercholesterolemia (high cholesterol)?

High cholesterol in children is usually linked to:

• Family history of early onset heart disease (familial hypercholesterolemia)

• Diabetes mellitus, Type 1 or Type 2

• Chronic kidney disease (CKD) (nephrotic syndrome)

• Obesity

• Hypothyroidism

• Liver diseases

• Diet

Cholesterol is found in certain foods made from animal products, including dairy products, eggs, meat and poultry. Fast foods and convenience foods are often high in saturated and trans fats that can cause the liver to make more cholesterol.

How is pediatric hypercholesterolemia (high cholesterol) treated?

Lifestyle changes are key to treating high cholesterol in children include:

• At least one hour of moderate to vigorous activity every day

• Screen time of less than two hours a day

• A varied diet high in fruits and vegetables and low in saturated and trans fats

When dietary and lifestyle changes don't reduce high cholesterol levels, children over 10 years may need lipid-lowering medication, such as a statin. Some children with medical conditions, such as diabetes or kidney disease, may need to start cholesterol-lowering medications at lower LDL levels.

Children with familial hypercholesterolemia typically start taking cholesterol lowering medications at an early age and need to see a lipid specialist.