Pediatric Dyslipidemia 

• Dyslipidemia is more harmful in children and young adults than in the elderly. Every 1% rise in total cholesterol boosts a young adult’s heart disease risk by 4-5%, compared to only by 1% in older adults.¹

• Increases in the blood levels of cholesterol and other lipoprotein fractions have consistently been shown to increase an individual’s risk for CAD (coronary artery disease). Several studies, including findings from the seminal Bogalusa Heart Study of children and adolescents, have shown that blood lipid levels “track” over time, though many individuals change their track, most typically downwards, with more prolonged observation. ²

• It is recommended that, at a minimum, children should have multiple determinations of their blood lipids performed to more accurately characterize their actual lipid profile, especially before instituting medical treatment that may last for life. ²

• Using established cut points, researchers have found that substantial proportions of individuals with high-risk blood lipid and lipoprotein levels at a young age, no longer had high-risk levels as adults. Of the participants who had high-risk levels in youth, those became obese or remained obese and/or those who commenced or continued smoking were more likely to maintain high-risk blood lipid and lipoprotein levels.³

• Unhealthy lifestyle changes that occur between youth and adulthood affect whether an individual maintains, loses, or develops high-risk blood lipid levels in adulthood. Interventions that promote weight control in the first instance, but also physical activity, not smoking, and improved socioeconomic status in the transition from youth to adulthood, are likely to be of benefit in preventing adult dyslipidemia.³

• These results support the potential value of screening for high cholesterol in childhood on a population basis. Screening and intervention program designed to promote nonsmoking, weight control, and a prudent diet is likely to yield great benefits.⁴

Table 130A. Acceptable, Borderline-High, and High Plasma Lipid, Lipoprotein and Apolipoprotein Concentrations (mg/dL) For Children and Adolescents* 2
Category	Acceptable	Borderline	High+
TC	170	170-199	200
LDL-C	110	110-129	130
Non-HDL-C	< 120	120-144	> 145
ApoB	< 90	90-109	> 110
TG
0-9 years	75	75-99	100
10-19 years	90	90-129	130
Category	Acceptable	Borderline	Low+
HDL-C	> 45	40-45	< 40
ApoA-I	>120	115-120	<115
*Values for plasma lipid and lipoprotein levels are from the National Cholesterol Education Program (NCEP)

•   In heterozygous hypercholesterolemia in which LDL cholesterol levels are minimally 160 mg/dL and typically over 200 mg/dL and total cholesterol levels exceed 250 mg/dL beginning in infancy, 50 per cent of men and 25 per cent of women experience clinical coronary events by age 50.²

• Approximately 50% of children with a family history of heart attack or personal history of stroke have elevated levels of Lp(a) ^{5 6}. In some families, isolated elevated Lp(a) levels have been seen with premature CAD and normal cholesterol levels.

FAQ

When to screen children for dyslipidemia?

No lipid screening is recommended for children until 2 years. It is recommended for children 2-8 years under the following conditions. Premature CAD in parents, grandparent, aunt, uncle or sibling; parent with dyslipidemia or TC>240; child has diabetes, high blood pressure, obesity or smoking; Child has a moderate- or high-risk medical condition. Universal screening at age 9-11 years and again at 17-21 years; non-HDL-C of >145  is considered high. Change in personal or family history warrants lipid evaluation at ages 12-16. ^{2, 7}

 Sources

1.Enas E.A., Hancy Chennikkara Pazhoor MD, Arun Kuruvila MBBS, Krishnaswami Vijayaraghavan MD F. Intensive Statin Therapy for Indians:Part I Benefits. Indian Heart J 2011; 63: 211-227.

2. Daniels SR. Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents:

 Report from National Heart, Lung and Blood Institute.Bethesda,http://www.nhlbi.nih.gov/guidelines/cvd_ped/index.htm2011. 

3. Magnussen CG, Thomson R, Cleland VJ, Ukoumunne OC, Dwyer T, Venn A. Factors affecting the stability of blood lipid and lipoprotein levels from youth to adulthood: evidence from the Childhood Determinants of Adult Health Study. Arch Pediatr Adolesc Med. Jan 2011;165(1):68-76. 

4. Stuhldreher WL, Orchard TJ, Donahue RP, Kuller LH, Gloninger MF, Drash AL. Cholesterol screening in childhood: sixteen-year Beaver County Lipid Study experience. J Pediatr. Oct 1991;119(4):551-556. 

5. Nowak-Gottl U, Langer C, Bergs S, Thedieck S, Strater R, Stoll M. Genetics of hemostasis: differential effects of heritability and household components influencing lipid concentrations and clotting factor levels in 282 pediatric stroke families. Environ Health Perspect. Jun 2008;116(6):839-843. 

6. Simma B, Martin G, Muller T, Huemer M. Risk factors for pediatric stroke: consequences for therapy and quality of life. Pediatr Neurol. Aug 2007;37(2):121-126. 

7. Daniels SR, Greer FR. Lipid screening and cardiovascular health in childhood. Pediatrics. Jul 2008;122(1):198-208.