In the July 2008 issue of "Pediatrics," the American Academy of Pediatrics (AAP) outlined new aggressive guidelines on pediatric lipid screening and heart health. Based on the growing obesity epidemic among American children, the AAP recommends baseline screening -- a fasting lipid profile test -- for at-risk children and adolescents begin between the ages of two and 10.
What will land kids on the at-risk list?
- Being overweight or obese This is especially true for kids who are at or above the 85th percentile for weight. Although the AAP recommends testing for all children with a body mass index (BMI) that indicates a weight problem, it's important to note that this might not be enough. A study conducted at the University of Michigan and published in August 2009 in the "Archives of Pediatric and Adolescent Medicine," suggests a child's BMI alone is not an adequate way to predict who should be screened for high cholesterol. According to the study, weight alone would miss about 50 percent of children with high cholesterol and 30 percent of kids would be unnecessarily tested.
- Having diabetes
- Having a family history of high cholesterol or premature heart disease (onset before age 55 for men, 65 for women) or a family history that is unknown
According to the American Academy of Pediatrics, children and adolescents ages 12 to 19 should aim for total cholesterol levels of less than 170 mg/dL, LDL levels less than 110 mg/dL, HDL levels 35 mg/dL or higher, and triglyceride levels less than 150 mg/dL.
If a child's results are normal, follow-up testing should be done in three to five years. But for those kids with high cholesterol readings, the next step is a visit to a pediatric cardiologist followed by a treatment plan.
For children who are overweight or obese, lifestyle changes are the first line of action. Nutritional counseling is helpful for creating a diet low in saturated fats and cholesterol. And exercise is key: According to the CDC, kids and teens should get 60 minutes (or more) of physical activity every day.
Are statins OK for kids? Prescribing statins to children and adolescents is still controversial because there is no long-term data available. However, both the AAP and American Heart Association's most recent recommendations include prescribing medications to pediatric patients who are unsuccessful with diet and lifestyle modifications (and who have given good effort to dietary changes and increased physical activity), especially when there is a family history that puts them at additional risk.