CHOLESTEROL

Cardiovascular disease is the leading cause of death and disease in this country. There are both genetic risk factors and environmental risk factors.  As pediatricians we can help to change the environmental risk factors by educating and counseling.  The risk factors for cardiovascular disease are high blood pressure, diabetes, cigarette smoking, obesity and high cholesterol.  The total cholesterol being elevated, as well as the LDL portion being elevated and the HDL (“good cholesterol”) being low are also strong risk factors.  For a child, it is recommended that the total cholesterol be less than 200, but preferably less than 170, the LDL be less than 130, but preferably less than 110, and the HDL be higher than 35, but preferably higher than 50.

For high risk patients, such as those with a family history of high cholesterol, obesity or cardiovascular disease, it is recommended that screening be done somewhere between the ages of 2 and 10.  If the family history is unknown, the same recommendation should be followed.  The most accurate testing is a fasting lipid profile.  In our office we generally screen all children at 3-4 years of age with a fingerstick total cholesterol right in the office and follow up with a lipid profile if the total cholesterol in our office is elevated.  The high risk patients should have their screening repeated in 3-5 years.

To reduce the risk of cardiovascular disease, children should eat a healthy diet, which should include low fat or non fat dairy products.  They should also eat more fruits, vegetables, fish and whole grains.  The intake of fruit juice, sugar-sweetened beverages and foods and salt should also be lowered.  The new recommendations also include limiting the intake of trans fatty acids to 1% of the total calories.  Physical activity is also extremely important. It helps to control obesity, raises the HDL, lowers the triglycerides and may also lower the LDL.

If we find that your child’s cholesterol is very high or going up, we may recommend a consult with a pediatric cardiologist.  Most children do not require medication for high cholesterol, but this is occasionally necessary, a determination which would be made by the specialist.