What is cholesterol?
Cholesterol is a waxy material found in the blood and the body's cells. It is called a lipid or a fat. We get cholesterol from our liver, which produces cholesterol, and from the food we eat.
The body needs some cholesterol. It helps to make cell membranes, some hormones and other body tissues. But too much cholesterol is bad for the body. Extra cholesterol from certain foods can be difficult for the body to clear and can build up in arteries. This increases the risk of heart disease and stroke.
What are the "good" and "bad" types of cholesterol?
Cholesterol is moved through the body by carriers called lipoproteins. There are good and bad kinds of lipoproteins:
- The good kind is called high-density lipoprotein (HDL). This type helps lower heart disease risk. It is thought that HDL takes cholesterol away from the arteries to the liver, which removes it from the body.
- The bad kind is called low-density lipoprotein (LDL). It helps raise heart disease risk. LDL forms a substance called plaque that can clog arteries.
What is hyperlipidemia?
Hyperlipidemia refers to high cholesterol levels in the blood. It is also called hypercholesterolemia. In adults, it is mainly caused by inherited risk factors (such as smoking and alcohol use as well as obesity) and a diet too high in fat.
Hyperlipidemia in children can be inherited from a parent (familial hyperlipidemia). It is also associated with obesity. Certain medical conditions and medications can also cause hyperlipidemia.
Causes of hyperlipidemia
Hyperlipidemia in children can be genetic (inherited), secondary to other conditions or medications, or due to diet.
There are many inherited genes that cause hyperlipidemia in children. Often, there is a family history of hyperlipidemia or heart disease at a young age in first degree relatives.
Secondary causes of hyperlipidemia include conditions and medications known to affect cholesterol levels. Patients with type 1 diabetes, hypothyroidism and some types of kidney and liver disease can have hyperlipidemia.
What is an acceptable cholesterol level?
Hyperlipidemia is diagnosed with a blood test. Acceptable levels vary by age and sex. Your child’s health-care provider can compare your child’s results to established normal values.
Treatment of hyperlipidemia
Lowering cholesterol levels in children and teens can help protect against heart disease. This can be done through diet, exercise and medication.
All children with hyperlipidemia benefit from regular physical activity and dietary modification. Adolescents should be counseled about the added risks of nicotine and smoking.
Children should be encouraged to eat at least five servings of fruits and vegetables daily, as well as a wide variety of other foods low in saturated fat and cholesterol. They should avoid fast foods, high-sugar and high-salt snacks (chips and chocolate bars) and soft drinks. A dietitian can provide more information on how to help you and your child make healthy food choices.
Severe hyperlipidemia that cannot be controlled by lifestyle changes and hyperlipidemia in children considered high risk for developing premature heart disease are also treated with medication. Children who have persistent hyperlipidemia despite lifestyle and diet changes also benefit from lipid-lowering medication. Examples of medication used include statins, bile acid resins, niacin, cholesterol absorption inhibitors and monoclonal antibodies. Statins are usually given to treat hyperlipidemia in children. They have been well studied and have been shown to lower cholesterol levels in children as young as age six. Some children with inherited hyperlipidemia may need a second medication to lower their cholesterol levels.
Regular checks of the blood's cholesterol level will also be needed to see whether treatment is working.
Hyperlipidemia in children can lead to early heart disease
Hyperlipidemia can lead to a build-up of plaque in the arteries (atherosclerosis). It is a major risk factor for the development of heart disease, which can lead to heart attacks, strokes and other conditions.
Children who inherit hyperlipidemia can have cholesterol levels up to four times as high as normal children. Without treatment, they can develop atherosclerosis by the time they are teenagers and run the risk of a heart attack in their 20s. Because children who have inherited hyperlipidemia are at especially high risk, they need specialized care to prevent atherosclerosis.
What is the outlook for children with hyperlipidemia?
When managed properly with an appropriate treatment approach, children with hyperlipidemia should be able to avoid major heart problems later in life. For some, diet will be enough. For others, medication will be needed.
Children who have defective genes from each parent are at especially high risk. They will need specialized care to prevent atherosclerosis.