A friend called recently for a second opinion about a cholesterol test ordered by her daughter's pediatrician. Was it really necessary to check her 4-year-old's cholesterol level? Even if it was found to be high, was there anything to do about it?
We used to believe that atherosclerosis, a narrowing of the arteries due to fat buildup, did not develop until late in life. Now we know that this disorder, which can lead to coronary heart disease and stroke, can begin early in life if a child's cholesterol levels are elevated.
To reduce the future risk of heart attack and stroke, children with high blood cholesterol must be identified and steps taken to keep their cholesterol levels in the healthy range.
Two major factors influence what a child's cholesterol level will be: diet and heredity. A diet high in cholesterol and fat, particularly animal fat and saturated vegetable fat, promotes higher blood cholesterol levels. Some children are even more susceptible to this problem because of an inherited tendency, and may have high blood cholesterol levels even if they eat carefully.
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To identify children with high blood cholesterol, the American Academy of Pediatrics recommends routine cholesterol screening for the following groups of children, ages 2 through 18.
* Children with biological parents or grandparents who, at 55 or younger, were diagnosed with coronary atherosclerosis. This includes parents or grandparents who had coronary artery disease detected on an angiogram as well as those who underwent angioplasty or coronary artery bypass surgery.
* Children with parents or grandparents who, at 55 years of age or less, suffered a myocardial infarction (heart attack), angina pectoris (chest pain), peripheral vascular disease, cerebrovascular disease (strokes or transient ischemic attacks, also called mini-strokes) or sudden cardiac death.
* Children of a parent with blood cholesterol of 240 milligrams per deciliter (mg/dl) or greater.
* Children whose parental or grandparental history is unknown.
Cholesterol screening may also be appropriate in children who have risk factors for coronary heart disease, such as adolescents who smoke cigarettes, have high blood pressure or are overweight.
If the test is done because a parent has high blood cholesterol, the total blood cholesterol should be measured. When the total cholesterol is 170 mg/dl or greater, a more detailed lipoprotein analysis should be obtained (this test measures levels of LDL cholesterol, the so-called bad cholesterol, and HDL cholesterol, the so-called good cholesterol). Intervention is recommended when the LDL is 110 mg/dl.
