Is Cholesterol Medication Needed in All Children Diagnosed With High Lipids?

Cholesterol Medication May Be Necessary in Some Children

High cholesterol can happen in children. But should they be placed on cholesterol medications for it? This issue is highly debated, and depends on your child's cholesterol levels and other risk factors they may have. The good news is that, in some cases, high cholesterol in children can be lowered without medication.

Cholesterol tests are usually performed in children who are at high risk of having high cholesterol, or their family history is not fully known. Risk factors for high cholesterol in children include:

• Lack of exercise
• Poor diet
• Certain inherited conditions involving abnormally high cholesterol levels

Your child’s pediatrician will determine whether or not cholesterol-lowering medication is needed based on your child’s LDL cholesterol levels, otherwise known as the “bad” cholesterol, and their risk factors for having heart disease.

Start With Lifestyle Changes First…

At first, your child’s pediatrician may attempt to implement changes in your child’s lifestyle. This would include:

• Incorporating exercise in your child’s daily activities
• A diet that is low in saturated fat
• Weight loss, especially if your child is obese
• Good control of blood sugar levels, if your child has diabetes
• Smoking cessation, if your child smokes

Instances Where Cholesterol-Lowering Medications Should Be Started

Beginning cholesterol-lowering medication in children is never an easy decision, but it could reduce heart-related complications later on in their lives.

According to guidelines designed by the American Academy of Pediatrics, medication is often considered after changes in your child’s lifestyle fail to bring their cholesterol down. This decision is also based upon their LDL cholesterol levels and other risk factors for heart disease. When lifestyle changes fail, and your child is eight years old or older, he may need a drug to lower his cholesterol if:

• LDL cholesterol level is greater than 190 mg/dL and has no additional risk factors for heart disease.
• LDL cholesterol level is greater than 160 mg/dL and has risk factors for heart disease, such as obesity, smoking, high blood pressure or a family history of heart disease early in life.
• LDL cholesterol level is greater than greater than or equal to 130 mg/dL – regardless of whether or not lifestyle modifications have been tried.

If your child is younger than eight years of age, lifestyle changes are often implemented when cholesterol levels are high. However, medications would not be considered in this population unless their LDL cholesterol is 500 mg/dL or higher. These dangerously high LDL cholesterol levels are usually seen in children with inherited conditions of high cholesterol, such as familial hypercholesterolemia. Additionally, if your child has another health condition, such as diabetes or kidney disease, his pediatrician may be a little more aggressive in treating his high cholesterol levels.

A few classes of cholesterol-lowering medications have been extensively studied in children and adolescents with high cholesterol levels, including:

• Statins
• Bile acid sequestrants
• Niacin

Your child’s healthcare provider will select the most appropriate medication for your child, and will monitor your child’s cholesterol levels, as well as any side effects, while the child is on this medication.

_Source:

Daniels SR, Greer FR et al. Lipid screening and cardiovascular health in childhood. Pediatrics 2008; 122:198-208.