The American Academy of Pediatrics (AAP) recently revised its 1998 policy on cholesterol guidelines for children and adults. This report, published in July 2008 in the journal Pediatrics, states that increasing rates of childhood obesity, type 2 diabetes, hypertension and cardiovascular disease have created a need for new guidelines. This report has updated its recommendations for prevention of heart disease, as well as indications for medical therapy for high cholesterol.
Types of Cholesterol
Cholesterol is a fatty substance produced by the liver and found in certain foods. Cholesterol is carried through the blood by proteins, which collectively are known as lipoproteins. Low-density lipoproteins (LDL) are considered "bad" cholesterol because they carry cholesterol to the arteries where it can form plaque leading to heart disease. High-density lipoproteins (HDL) are considered "good" cholesterol because they carry cholesterol to the liver where it is removed from the body. Triglycerides are a type of fat in the blood that are carried by lipoproteins, and thus also contribute to heart disease.
Guidelines for Screening
The AAP follows the cholesterol screening recommendations created by the National Cholesterol Education Program (NCEP), established in 1992. It recommends that children and adolescents with a family history of elevated cholesterol or premature heart disease be screened. Children should also be screened if family history is not known or they have risk factors for heart disease such as high blood pressure, diabetes, obesity or cigarette smoking. Screening should occur after age 2 but no later than age 10. The AAP recommends that children with normal cholesterol levels have testing done once every three to five years.
Pediatric Cholesterol Levels
For children and adolescents age 2 to 19 years, total cholesterol levels should be less than 170 mg/dL and LDL less than 110 mg/dL, according to the American Heart Association. It is considered borderline-high if total cholesterol falls between 170 and 199 mg/dL and LDL is 110 to 129 mg/dL. It is considered high if total cholesterol is greater than 200 mg/dL and LDL is greater than 130 mg/dL. In addition, HDL should measure 35 mg/dL or higher and triglycerides less than 150 mg/dL.
Treatment
The AAP still emphasizes diet and exercise as the cornerstone of treatment for high cholesterol. However, with the creation of new cholesterol medications since the last report, the AAP has implemented new guidelines on medical treatment of high cholesterol. Medical intervention may be initiated in children 8 years and older with an LDL greater than 190 mg/dL with no risk factors, or if diet and exercise have not been successful. Children with an LDL greater than 160 mg/dL having a family history of premature heart disease or at least two risk factors for heart disease should also undergo medical treatment. Those with diabetes with an LDL of at least 130 mg/dL should consider medical therapy too.
Prevention
The AAP recommends that children older than age 2 and adolescents follow the recently updated "Dietary Guidelines for Americans" by the Department of Health and Human Services to help parents and children make good food choices as well as to learn good exercise habits.
