Pediatrics - High Cholesterol

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Introduction

High cholesterol occurs when there is too much or an unhealthy balance of cholesterol in the blood.  Both children and adults can have high cholesterol.  Your child’s body needs some cholesterol for healthy functioning, but too much is dangerous to your child’s health.  High cholesterol has no symptoms.  The only way to find out if your child has high cholesterol is to have your child tested with a simple blood test.  High cholesterol is treated with lifestyle changes, dietary changes, and medications.  Untreated high cholesterol increases the risk for heart and blood vessel disease, including heart attack and stroke.
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Anatomy

Cholesterol is a fat-like substance that is essential to your child’s health. Your child’s body obtains cholesterol from the foods, but the majority of cholesterol is produced by your child’s liver.  Cholesterol is a component in your child’s blood, cells, and body tissues.  Your child’s brain, nerves, muscles, skin, liver, intestines, and heart use it to function.  Your child’s body uses cholesterol to produce hormones, vitamin D, and bile that helps to digest fat.  Cholesterol helps your child’s nerves and brain send messages.  Cholesterol is also a component of body fat.  Your child’s body needs cholesterol to be healthy; however, too much cholesterol is dangerous to your child’s health.
 
A total cholesterol test shows the total amount of cholesterol in your child’s blood.  A more detailed test, a lipid profile, includes lipoprotein measurements that are more useful and reflective of your child’s health.  Cholesterol travels out from the liver and into the bloodstream on fat and protein carriers called lipoproteins.  The two main types are low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol. 
 
Most cholesterol is LDL.  LDLs transport cholesterol away from the liver and into the bloodstream.  LDLs contain more fat than protein.  LDLs are more likely to collect on the walls of blood vessels, which can contribute to heart disease, including heart attack and stroke.  LDLs are the “bad” cholesterol.  To help people remember, the “L” in LDL is commonly referred to as “lousy.”  You want your child’s LDL numbers to be low.
 
HDL cholesterol contains more protein than fat.  HDLs carry cholesterol away from arteries and out of the body.  High HDL levels can reduce the risk of heart attack.  HDLs are the “good” cholesterol.  The “H” in HDL is commonly referred to as “healthy.”  You want your child’s HDL levels to be high.
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Causes

High cholesterol occurs when there is too much or an unhealthy balance of cholesterol in the blood.  High cholesterol can lead to narrowed and clogged arteries and contribute to heart disease, including heart attack and stroke.  Eating high-fat or high-cholesterol foods and inherited factors are believed to be the primary causes of high cholesterol.  Your child’s genes control how fast LDL is produced and removed from your body.  This is a factor for high cholesterol that your child has no control over.  Some people have familial hypercholesterolemia, a specific form of high cholesterol that is inherited. 
 
Certain medical conditions, such as liver disease, diabetes, Cushing’s syndrome, kidney disease, or an underactive thyroid, can contribute to high cholesterol.  Certain medications including birth control pills, estrogen, corticosteroids, some diuretics, and beta-blockers can increase cholesterol levels. 
 
Lifestyle factors, such as smoking, excessive alcohol consumption, and lack of exercise, are associated with high cholesterol.  Your child’s weight is another factor.  Excess weight can increase your child’s LDL level. 
 
Both children and adults can have high cholesterol.  Cholesterol levels tend to increase with age.  For women, cholesterol typically increases around menopause.
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Symptoms

High cholesterol has no symptoms.  The only way to find out if your child has high cholesterol is to have your child’s cholesterol tested.  Regular cholesterol testing should begin at age twenty, unless otherwise specified by your doctor.
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Diagnosis

Your child’s total cholesterol level can be identified with a blood test.  If your child’s test reveals high cholesterol, another blood test called a lipid panel is used to determine your child’s LDL, HDL, and triglyceride levels.  Triglycerides are fats that are used to build cholesterol.  High levels of triglycerides can contribute to heart disease.  Your doctor will explain the desirable cholesterol ranges for your child.
 
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Treatment

The goal of treatment for high cholesterol is to lower cholesterol levels into the healthy ranges to reduce the risk of heart disease.  High cholesterol is treated with lifestyle changes, special diets, and medications.  Your doctor will make specific recommendations for your child based on the results of your child’s lipid profile.
 
Your child should make lifestyle changes to reduce the risk factors that can be controlled.  This includes not smoking, losing weight, maintaining a healthy weight, and exercising regularly.  Exercise can help raise HDL and lower LDL. 
 
Your child should eat a low fat, low cholesterol, high fiber diet.  The National Cholesterol Education Program, a division of the National Heart, Lung, and Blood Institute, has eating guidelines for people with high cholesterol.  The American Heart Association’s Cholesterol Low Down is another good resource for eating and exercise guidelines.  Your doctor may make specific recommendations or refer you to a nutritionist for healthy meal planning.
 
If lifestyle and dietary changes alone do not lower your child’s cholesterol into healthy ranges, your doctor will prescribe cholesterol lowering medications.  There are several types of prescription medications that work in different ways to lower cholesterol.  It is common to use more than one type of medication and for medications to change over time.
 
After a high cholesterol diagnosis is made, your child will receive regular monitoring by your doctor.  Your doctor will evaluate your child’s cholesterol levels, the effectiveness of medications, and check for any medication side effects (some medications may affect liver function).  It is important that medications are taken per your doctor’s instructions and that you make and keep all of your child’s follow up appointments.
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Prevention

Your child may be able to reduce the risk factors for high cholesterol that can be controlled.  Lifestyle changes, such as not smoking; eating a low fat, low cholesterol, and high fiber diet; maintaining a healthy weight; and getting regular exercise can help reduce your child’s risk for high cholesterol.  Cholesterol lowering medications can reduce your child’s cholesterol to healthy levels and lower your child’s risk for heart disease.  You should make and attend all of your child’s follow up appointments with your doctor.
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Am I at Risk

Is My Child at Risk?

There are risk factors for high cholesterol that your child can and cannot control.  Your child can reduce his or her risk for high cholesterol by eliminating the risk factors that he or she can control.

Risk factors for high cholesterol:

_____ Your child cannot control the genes that he or she inherited.  Your child’s genes determine how fast his or her body produces and removes LDL. 
_____ Some people have familial hypercholesterolemia, a specific form of high cholesterol that is inherited. 
_____ Cholesterol levels tend to rise with age.  Cholesterol levels tend to rise for men at age 45.
_____ Females tend to experience higher levels of cholesterol after menopause.
_____ Being overweight or obese is associated with an increased risk of high cholesterol.
_____ Smoking can increase cholesterol.  People that smoke and have high cholesterol have a greater risk for heart disease and stroke.
_____ Excessive alcohol consumption can raise cholesterol levels.
_____ A sedentary lifestyle or a lack of exercise increases the risk for high cholesterol.
_____ Certain medications, including birth control pills, estrogen, corticosteroids, some diuretics, and beta-blockers, may cause cholesterol levels to rise.
_____ Some medical conditions, such as liver disease, diabetes, Cushing’s syndrome, kidney disease, or an underactive thyroid, may contribute to high cholesterol.
_____   Eating food that is high in cholesterol or fat can increase the risk of developing high cholesterol.  Foods that come from animals have cholesterol, including meat, fish, poultry, shellfish, eggs, butter, cheese, and milk—plus products that contain these ingredients.  Foods that contain saturated fats and trans fats can raise your cholesterol levels.  Fats are most often found in high-cholesterol foods, margarines, baked goods, and processed foods, such as chips, crackers, and snack items.

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Complications

The major concern about high cholesterol is that it is a major risk factor for heart disease and stroke.  High cholesterol can cause deposits on artery walls that lead to arterial narrowing and blockages.  High cholesterol is associated with an increased risk for heart attack and stroke.
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Advancements

Cholesterol lowering medications, especially statin drugs, have improved the treatment of high cholesterol.  Lowering cholesterol is useful for preventing heart and blood vessel disease.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.