High cholesterol in kids: Helping kids prevent heart disease

A child can have high cholesterol because of their genetics or their lifestyle habits. Your child may have a higher risk if they:

• Have a family history of high cholesterol or early history of heart attacks or strokes

• Eat a lot of processed foods or snack foods, fast food or sugary beverages

• Do not get much physical activity

All children should have their cholesterol checked between ages 9-11. This test can be done by your child’s pediatrician during a Well Child visit.

What is cholesterol?

Cholesterol is a waxy substance that floats in our blood. It helps make things like vitamins and hormones, but in too high amounts can lead to heart disease, like heart attacks or strokes.

• LDL is the bad cholesterol (think “L" for "lousy”)

• HDL is the good cholesterol (“H” for "happy”)

• Triglycerides are a fatty substance in the blood that floats with cholesterol.

LDL levels should be less than 110 mg/dL. HDL should be above 45 mg/dL. Triglycerides vary based on a child’s age and whether they fast before the test. For fasting tests, triglycerides should be less than 90 for children ages 10 and older and less than 75 for children 9 and under.

If you have a family history of high cholesterol or early heart attacks or strokes, your doctor may order a lipoprotein (a) test. Lipoprotein (a) is attached to the LDL cholesterol and if it is high, makes the LDL extra “sticky.” Having high lipoprotein (a) – even with a normal LDL – can increase the risk of heart attack and stroke.

Learn more

Treatment for high cholesterol first focuses on making healthy lifestyle choices, including diet and exercise.

Healthy eating

All children can benefit from these healthy eating tips:

• Increase fruits and vegetables and decrease processed foods as much as possible

• Increase fiber with more whole grains, beans, broccoli, spinach or carrots

• Use olive oil or canola oil instead of butter

• Avoid sugary drinks like juice, soda or sports drinks

• Save bakery products for special occasions

• Grill or bake foods instead of frying them

• Replace french fries at restaurants with a fruit or vegetable for a side

• Eat chicken and fish more often and limit red meat consumption (such as beef)

• Drink skim or 1% milk (chocolate milk should be a treat)

• Drink water all throughout the day (50-60 ounces of water per day)

• Eat meals together as a family

More heart-healthy eating tips

Children between the ages of 9 to 11 and 17 to 21 should have their cholesterol checked, including non-fasting lipids or their total cholesterol and HDL.

Fasting lipids

Fasting lipids should be checked between the ages of 2 and 8, or 12 and 16 if the child has any of the following risk factors:

• Family history (MI, CABG, sudden cardiac death in males <55, females <65)

• Obesity

• Diabetes (Type I or II)

• Kidney disease or history of kidney transplant

• Heart transplant

• Kawasaki disease

• Chronic inflammatory disease

• HIV

• Childhood cancer survivor

When to refer to the Pediatric Preventive Cardiology Clinic

• When to order a fasting panel for a child and refer to the clinic:

  • LDL >110

  • HDL <45

  • Trig >110 on a non-fasting panel in children ages 2-9 or >130 in children ages 10-19

  • non-HDL >145

• If the patient has abnormal fasting lipids, especially if the patient has risk factors listed above.

• IF LDL >190 or TG >500 at any time