High cholesterol in children
Clinical signs of atherosclerosis — fatty build-ups in the arteries — can sometimes be seen as early as childhood. These fatty build-ups lead to a progressive narrowing and hardening of the arteries that can cause premature death or disability through heart attack or stroke.
The same risk factors that put adults at risk of developing atherosclerosis also put children at risk. These risk factors include high blood pressure, obesity, cigarette smoking, diabetes and high cholesterol. Some children will be more at risk because of a genetic (inherited) predisposition to high blood cholesterol.
So, high blood cholesterol levels in children make these fatty build-ups in the arteries more likely and there is increasing evidence that the process of atherosclerosis can start in childhood and then progress slowly into adulthood.
Just as for adults, in children with high cholesterol, the higher the number of cardiovascular risk factors, the greater the risk of atherosclerosis, even though there may be no symptoms. For example, an overweight teenager who has raised cholesterol levels and smokes is likely to have more fatty deposits in their arteries than a similar aged non-smoker with an acceptable body weight, who might also have an elevated cholesterol level.
Testing cholesterol in children
Most children do not need to be tested for blood cholesterol levels. However, children with diabetes or children who have a first-degree relative (parent, brother or sister) who has had coronary heart disease before the age of 60 may be tested to identify whether any steps should be taken to prevent future heart disease. Testing may also be appropriate in other conditions such as liver or thyroid disease.
Testing is usually unnecessary for children under 2 years old, as they should not undergo dietary restrictions prior to that age because they have special nutritional needs for fat.
There is some evidence to show that testing of adolescent blood cholesterol levels can be inaccurate as the hormonal changes at puberty can mask high blood cholesterol levels. This means that there is a risk of getting a falsely low cholesterol reading, so teenagers at high risk of heart disease should be tested again after reaching young adulthood to get a more accurate result.
Healthy lifestyle
All children, but particularly those with elevated cholesterol levels, should be encouraged to lead an active lifestyle and follow a healthy diet. And, of course, smoking should be strongly discouraged.
A heart-healthy diet means eating less saturated fat, less total fat and less cholesterol. This can be achieved by eating lean meat, a wide variety of fruits, vegetables and wholegrain cereal products, using low-fat dairy products, eating fish 2-3 times a week, and limiting snack food, takeaway food, cakes and biscuits. Such a diet also has the added advantages of meeting the increased needs of children and teenagers for nutrients such as calcium, iron and zinc.
Research has also shown that cholesterol-lowering products enhanced with plant sterols can reduce cholesterol levels. In Australia, the foods that are approved for enrichment with plant sterols include margarine spreads, breakfast cereal, low-fat yogurt and low-fat milk. Most children do not need these products, but they may be useful in the diets of children with elevated cholesterol. However, studies have found that the cholesterol-lowering effect of these products is reduced in children compared with adults.
As well as dietary restrictions, encouraging regular aerobic exercise and reducing the number of hours that children spend watching the television or using the computer can also help reduce their risk of cardiovascular disease.
Obese children and adolescents are more likely to have poorer health as adults, regardless of whether they are obese as an adult or not.
When lifestyle changes are not enough
Some children may have severely high cholesterol levels as a result of genetic disorders. The use of bile-acid-binding resins (cholestyramine and colestipol) may be recommended in such cases, but they are often not well accepted by children.
Emerging research appears to be suggesting that statins — cholesterol lowering medicines that are commonly used in adults — are safe and effective in lowering cholesterol in children. However, this is an ongoing area of research, and the long-term effects have not been extensively studied in children. For this reason, your doctor may recommend strict lifestyle changes and review the need for medication when your child reaches early adulthood.
A medication called ezetimibe (brand name Ezetrol) may be used to lower cholesterol in children. It is the first available medication in a new class of cholesterol lowering medicines known by doctors as cholesterol absorption inhibitors, and it is generally well tolerated. Ezetimibe is not recommended for children under 10 years of age. More research is needed to determine the long-term effectiveness of this medicine in children.
Last Reviewed: 12 December 2008
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