Cholesterol Screening in Children: The Current Debate

High blood levels of "bad cholesterol" (low-density lipoprotein or LDL) and low blood levels of "good cholesterol" (high-density lipoprotein or HDL) are among the greatest risk factors for heart disease.

The American Heart Association sites heart disease as the number one cause of death and illness in the U.S. Although the disease manifests in adults, it begins in childhood and worsens with age

As the number of overweight children has increased to epidemic proportions, undesirable cholesterol levels and undesirable cholesterol ratios (ratios of HDL to LDL) have been more common in pediatric patients.

In July 2008, The American Academy of Pediatrics began recommending screening for elevated cholesterol in some children. The first screening should be done in children between the ages of 2 and 10 who are at risk for heart disease. Risk factors for heart disease include obesity, diabetes, or high blood pressure. Cholesterol screening is also recommended if the family history is positive for high cholesterol or any of the risk factors or if family history is not known.

If test results are within normal ranges for cholesterol and cholesterol ratios, the tests should be repeated within three to five years. Screening for abnormal pediatric cholesterol levels should be done during well-child checks or other regular check-ups.

If Cholesterol Levels Are Normal

A healthy lifestyle is recommended for all children, even if cholesterol levels are normal. Normal weight for height and age and adequate physical activity are targeted. Low-fat or fat-free milk and low-fat dairy products are best for children above the age of two. Doctors may recommend milk with reduced fat content for obese babies between one and two years of age, and for babies from families with a history of being overweight.

If Cholesterol Levels Are High or There Are Risk Factors

Goals for children who are at risk or who are from high-risk families should include the above lifestyle changes.

Soluble fiber may also be recommended. Itworks by trapping cholesterol in the gut so that it is not reabsorbed. Soluble fiber is found in beans and peas, oats, rye, barley, and some fruits and vegetables. Supplements are also available.

A healthy diet should be instituted, containing no more than 7% of daily calories from saturated fat and no more than 200mg of cholesterol per day. Nutritional counseling is often a good idea to try to help families institute these dietary changes.

If cholesterol remains high after six months to one year of the above lifestyle changes, drug therapy may be indicated for children who are at least eight years old. Some younger children are also treated with drugs if their LDL cholesterol levels are drastically elevated.

Drugs That May Be Used

Drugs that bind up cholesterol in the intestines and keep it from being reabsorbed are used to treat high cholesterol in some adults, but these can upset younger tummies and are not widely tolerated in children.

Niacin, a B vitamin, is used to effectively lower LDL cholesterol in adults. It has side effects that include flushing, liver failure,muscle disease, and blood sugar irregularities. Because these side effects can occur commonly in children, niacin is not recommended.

Pravastatin (Pravachol is a brand name) is a cholesterol-lowering "statin" drug that has been approved for children as young as eight years. Other statins are approved for ten years and older. Statins are considered safe and effective short-term treatments, based on reliable studies. They are recommended as the first choice when drug treatment for high cholesterol in children and young adults becomes necessary.

Other potential first-line drugs are being investigated for use in lowering cholesterol in children.

Why The Debate?

The long-term effects of drugs that lower cholesterol in children are not known. There is also the chance that if HDL and LDL levels are normalized with drugs, less emphasis will be placed on weight loss, healthy diet, and exercise.

Although there are studies that show that drugs will lower bad cholesterol in children, there are no studies in children that prove that drug treatment reduces death and illness due to heart disease.

Other Non-Drug Approaches

Plant sterols may have some effect in lowering cholesterol. They are sometimes added to manufactured foods and supplements are available. There is concern that sterols may reduce the absorption of necessary oil-soluble vitamins and some nutrients.

Talk to your pediatrician about your child's risk and find out the course that should be followed in your child's case. Ask your doctor to recommend a nutritionist if you need help understanding the dietary guidelines for keeping cholesterol in normal ranges.

Do everything possible to keep your child fit and within normal weight limits. Learn how to institute a healthy diet. Learn to read labels and learn what they mean. Avoid hydrogenated fats and limit saturated fats as recommended above. Avoid products high in sugar and salt. Opt for foods high in fiber or ask your doctor if a supplement should be given. As you learn more, get your children involved so they can learn. Beneficial changes should become lifelong habits.

DISCLAIMER: This article is provided for information only. This information is not a substitute for professional medical care by a qualified doctor or other health care professional. I am not responsible or liable, directly or indirectly, for any form of damages whatsoever resulting from the use (or misuse) of information contained in or implied by the information. This information is in no way intended as a recommendation of any cholesterol drug therapy or other cholesterol treatment and is not intended as a diagnosis of any problem you or your child may have.

The above information is given only as a reference to educate you about current concerns regarding cholesterol in children and its possible effects. Never substitute anything you read anywhere on the Internet for the advice of a qualified doctor!

SOURCES:

Stephen R. Daniels, MD, PhD, Frank R. Greer, MD and the Committee on Nutrition, "Lipid Screening and Cardiovascular Health in Childhood." Pediatrics, Official Journal of the American Academy of Pediatrics, Vol. 122 No. 1, July 2008, pp. 198-208

Author not given, "Heart Disease and Stroke Statistics." American Heart Association.

Article, author not given, "Dyslipidemia." Pharmacist's Letter, August 2008; Vol: 24, page 44.