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What You’ll Learn:
- How the cholesterol guidelines recently changed to include childhood testing.
- Healthy cholesterol ranges for children and teens.
- Risk factors that indicate an increased need for cholesterol testing in childhood.
- What can be tested in addition to LDL cholesterol to gauge risk.
The American Heart Association in conjunction with 10 other medical associations recently updated its guidelines for healthy cholesterol levels. The sweeping changes were in response to the realization that previous guidelines were somewhat inaccurate, target LDL cholesterol levels weren’t low enough and earlier intervention is needed to curb cholesterol problems.
That last point is something that every parent should pay attention to moving forward. Within the new guidelines are recommendations for children as young as nine years old. That’s right. Your child’s cholesterol levels are something you should start thinking about in elementary school.
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Changes in the AHA Cholesterol Guidelines Include Testing in Childhood
Cholesterol is present in our bodies from birth. It’s actually needed for fetal development. However, like so many things in life, having too much is a bad thing. And in terms of cholesterol, levels may be low at birth but can become elevated early in childhood.
Low density lipoprotein (LDL) cholesterol is an indicator of a person’s cardiovascular disease risk. Genetics and lifestyle habits can play a role in elevating LDL-C from a very early age.
This is why childhood cholesterol testing was included in the recent American Heart Association guidelines. The recommendation is that testing should start when children are 9-11 years old.
The reasoning for the recommendation is clear: detecting elevated cholesterol levels earlier helps prevent health problems in the future. It also helps identify lipid disorders that need to be managed and help determine if further genetic testing is needed.
“People who maintain low levels of LDL cholesterol and triglycerides at earlier ages are much less likely to develop atherosclerotic disease decades later. Taking action early in life is critical because high cholesterol begins to impact your heart disease risk even in adolescence,” says Dr. Pamela B. Morris, the vice-chair of the AHA guideline writing committee.
But checking once when your child is 9-11 years old isn’t enough. Even if they are within the healthy range, it’s recommended that cholesterol be checked again between the ages of 17-21. It’s known that cholesterol levels can drop during puberty but then increase significantly afterward. Checking again in the late teens or early 20s provides an early look at cholesterol in adulthood.
Knowing cholesterol levels in childhood helps parents make decisions regarding their child’s health that can have an impact for decades to come. During these formidable years, it’s also easier to encourage and establish lifestyle habits that keep cholesterol in check for the rest of their life.
Healthy Cholesterol Ranges For Children and Teens
What’s considered a healthy cholesterol level was also updated in the most recent AHA guidelines. The American Heart Association and others determined that the target LDL cholesterol numbers needed to be lower than previously recommended.
The LDL cholesterol recommendations are now:
Less than 100 mg/dL for anyone with borderline or intermediate risk
Less than 70 mg/dL for those at high risk
Less than 55 mg/dL for very high risk individuals
In general, you want LDL-C to be as low as possible regardless of age or risk. If LDL cholesterol is high, action should be taken to lower it. In most cases, lifestyle adjustments should be made first. Lifestyle changes include more physical activity, improved sleep and dietary adjustments. If lifestyle changes alone don’t lower LDL cholesterol into a healthy range, further lipid-lowering treatments may be recommended.
Early intervention is extremely important because how long someone is exposed to high levels of LDL cholesterol directly impacts Atherosclerotic Cardiovascular Disease (ASCVD) caused by plaque buildup in the arteries. Since lipid lowering treatments are clinically proven safe for children, there’s no downside to treatment starting in childhood.
GOOD TO KNOW: 20% of adolescents have lipid abnormalities.
Risk Factors That Indicate Cholesterol Testing Should Start in Childhood
High cholesterol levels in childhood is associated with a higher risk of cardiovascular disease in adulthood. But are there indications that a child could have high cholesterol?
Just like adults, some children exhibit risk factors that increase the need for cholesterol testing. While it’s recommended that all children get tested between the ages of 9-11, it’s particularly important it there’s:
Family History of High Cholesterol
If high cholesterol runs in the family, it's a good reason to get your child tested as early as possible. Familial Hypercholesterolemia (FH) is a genetic condition that can cause high cholesterol essentially from birth.
High BMI or Obesity
If your child’s body mass index (BMI) is above the healthy range or their weight puts them in the obesity category, you should highly consider having their cholesterol levels checked.
Diabetes, Hypothyroidism and Kidney Disease
Some health conditions can lead to high cholesterol. Diabetes, hypothyroidism and kidney disease are conditions that increase risk in children and adults.
Diet That’s High in Saturated and Trans Fats
If a child consumes a lot of saturated and trans fats it increases the likelihood of high LDL-C levels.
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Biomarkers to Test in Addition to LDL Cholesterol
Another new recommendation from the American Heart Association is that we should be testing for more than LDL and HDL cholesterol. New heart health biomarkers have been identified that provide a clearer picture into cardiovascular risk, including if someone is genetically predisposed to arterial plaque buildup.
The AHA specifically is calling for people to test their Lp(a), apoB and hsCRP levels to get a better idea of their cardiovascular risks.
Lipoprotein(a) [Lp(a)]
Lipoprotein is an LDL-C particle that is determined by genetics. Lp(a) is “stickier” than other LDL particles, which is why it’s associated with plaque buildup in arteries and blood clots.
Apolipoprotein B (apoB)
Apolipoprotein (apoB) has been linked to ASCVD, and it’s now believed that apoB can be a more accurate assessment of risk than LDL-C. ApoB is a protein that’s found on lipoproteins that form plaque. Each particle has one apoB molecule making it possible to get an exact measurement of particles in the blood.
High-Sensitivity C-Reactive Protein (hsCRP)
High-sensitivity C-reactive protein (hsCRP) is generated in the liver, but it’s an indicator of widespread inflammation. When hsCRP is chronically elevated it’s an indication of vascular inflammation that can suggest an increased risk for cardiovascular disease even if LDL levels are normal.
While you can’t influence Lp(a) levels, you do want to lower apoB and hsCRP as much as possible. That starts with understanding if your levels are elevated.
Testing is a personal choice that every parent has to make for their child. Getting tested yourself first can help ease any anxiety you may be feeling and provide valuable information so you’re better prepared.
Choose Health has one of the most advanced cardiovascular at-home testing kits. In addition to LDL-C and HDL-C, our test provides levels for Lp(a), apoB and hsCRP. With one test you can check all of the biomarkers that are recommended by the American Heart Association.
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