Guess who has high cholesterol?
Screening 9-year-olds for high cholesterol may seem like an unusually bold move to some parents. Hyperlipidemia, the “grown-up” name for a grown-up condition, is not generally perceived as a pediatric concern.
It is now.
Testing your children for high cholesterol is now the norm, according to new guidelines that recommend all children between ages 9 and 11 have their blood drawn and tested for high cholesterol.
The expert panel, appointed by the National Heart, Lung, and Blood Institute, released the new guidelines in November 2011. The guidelines, endorsed by the American Academy of Pediatrics, also recommend a recheck between ages 17 and 21.
The science behind the panel’s recommendation stems from the fact that fat and cholesterol build up in the blood vessels during childhood, later contributing to a greater adult risk of heart attack and stroke. Screening for —and addressing— high cholesterol at a young age may prevent the disorder in the adult years, as well as prevent other life-threatening cardiovascular events.
To answer some of our questions related to these new guidelines, HealthLeader spoke with Mfon Ekong, MD, FAAP, assistant professor of pediatrics, at The University of Texas Health Science Center at Houston (UTHealth) Medical School.
What does having ‘high cholesterol’ really mean?
It means there are elevated blood levels of cholesterol in the body. Cholesterol is a lipid, or type of fat that can put the body at risk for accelerated plaque formation in the blood vessels closest to the heart. This plaque or fatty composite can lead to blockage of the vessels that supply the heart with blood and oxygen. [A plaque is a thick, waxy substance made up of cholesterol and other fats, calcium deposits and other cellular debris. High cholesterol over time can contribute to the creation of plaque.]
This translates to an elevated risk for heart attack and other problems, such as high blood pressure and stroke.
All the blood in the body circulates back to the heart and lungs to pick up more oxygen cargo to supply bodily functions. When the blood vessels fill with plaque, it decreases the amount of blood that reaches the heart. A traditional heart attack occurs because there is a lack of good, unimpeded oxygen-bearing blood flowing back to the heart. That is the biggest event you want to prevent.
Adults with elevated cholesterol have an increased risk for cardiovascular disease. Since plaque can form in the blood vessels starting in childhood, screening children at an early age and employing methods to lower levels can hopefully lead to a decreased risk of severe disease in the future.
Is high cholesterol a predictor for high cholesterol/heart problems later in life?
It is a high predictor for persistent hyperlipidemia and cardiovascular disease.
What does the obesity epidemic have to do with this?
(Editor’s Note: The latest figures from the US Centers for Disease Control and Prevention report that an estimated 17 percent of American children and adolescents ages 2-19 years are clinically obese. Some states have a significantly higher percentage of overweight or obese children.)
These guidelines give health care providers another set of tools in the fight against childhood obesity. According to the Texas Department of State Health Services, in 2004-2005, the overall prevalence of overweight and obesity in Texas fourth-graders was 42 percent. With these disturbing numbers, those who provide medical care to children are charged with assessing risk of serious disease and providing preventive care.
Do kids metabolize fats differently from adults? How do fats break down in our bodies?
Children and adults process fats the same way. When you take in fatty foods, your stomach does some of the processing, but mostly, the liver is your main organ for processing fat. The liver takes just what you need for energy and processes it right away. The surplus – the extra intake of fats that the body just doesn’t need – gets deposited along the sides of your blood vessels in these cholesterol plaques. If you’re burning more fat [through exercise, for instance] or eating less of it, the liver doesn’t have any extra to deposit.
What else do the new guidelines recommend that pediatricians do?
The guidelines from the National Lipid Association recommend screening all children for hyperlipidemia by the age of 9 to 11 years. This means a blood draw at a doctor’s visit, most commonly during a well-child checkup. Once results are available, the physician will determine if the patient has low risk for future heart disease, if the patient needs diet and exercise modification, or if he or she needs referral to a specialist.
What are the risk factors for high cholesterol in kids?
- Family history of premature heart disease
- At least one parent with hyperlipidemia
Should children be tested earlier than age 9 if there is a known risk or family history?
Yes, they should. Early detection is the best prevention. Once risk factors are identified, it is important to screen the patient immediately. The opportunity to treat a serious condition is at hand
Is high cholesterol genetic?
Certain cases of high cholesterol are genetic. These cases are found in families who report having members on medication to lower cholesterol and/or having heart disease at an earlier age due to elevated cholesterol. When screening children with a blood test, these cases can be identified and managed by a specialist.
Is high cholesterol reversible?
Through close physician management, reduction in cholesterol levels can occur with dietary changes, such as reducing animal and saturated fats, increasing exercise and physical activity, and, in some cases, medication management.
What can parents do to reduce their child’s risk of high cholesterol?
At home, parents can provide healthy, balanced meals for the whole family, reduce excess fat intake and encourage at least 30 minutes of daily physical activity. At the doctor’s office, parents need to disclose their family history and openly discuss lab testing or other recommendations given by the physician.
If a child tests high for cholesterol, what’s the next step or treatment plan?
The physician will need to contact the family and have them return to the office to review the results. There will be instructions on how to change your child’s diet and increase physical activity. Most likely there will be a need for future blood tests as well. In certain cases, referral to a specialist may be necessary for further evaluation that also may include starting on medication.
Are cholesterol lowering drugs safe for kids?
Yes. Prior to starting any new medication, the physician should discuss with the parents how the medication works and any adverse effects.
What advice can you offer concerned parents?
A fair number of parents, especially those who are plugged into current events and guidelines, may get frustrated with their doctors always discussing new testing, new recommendations, and putting their children through something that’s a little bit painful. The hope is that all families trust their doctors, and feel they can speak openly with their physicians about their concerns. Together, they can come up with a good plan that benefits the whole family, the children as youngsters, and as they grow into adulthood. This is an investment toward a lifetime of good health.