The new guidelines, published in the journal Pediatrics, are an effort to prevent the burden of cardiovascular disease that starts in youth through early intervention.
The authors write: "Atherosclerosis begins in youth, and this process, from its earliest phases, is related to the presence and intensity of the known cardiovascular risk factors. Clinical events such as myocardial infarction, stroke, peripheral arterial disease, and ruptured aortic aneurysm are the culmination of the lifelong vascular process of atherosclerosis."
Screening is recommended between ages 9 and 11 and then again between 18 and 21 years. Unless there are risk factors for heart disease, routine non-HDL cholesterol screening can be done, which doesn’t require children to fast.
Children whose parents or other close relatives - parents, grandparents, aunts or uncles - have had heart trouble should first cut down on cholesterol intake. Plant sterols, found in some margarines might be effective short-term to bringing down cholesterol levels in children who don’t respond to dietary changes.
Children whose LDL levels are 190 mg/dL or above, who are at least 10 years old and haven't responded after six months of diet and lifestyle changes, or whose LDL is 160 to 189 mg/dL with risk factors, should be treated with statins. The goal is to lower LDL – the ‘bad’ cholesterol- to less than 130mg/dL.
Recommendations for maintaining healthy cholesterol levels in children and young adults include avoidance of tobacco – first or second-hand, breastfeeding and a low saturated fat diet after age 1 plenty of physical activity.
Blood pressure checks should begin at age 3 and glucose testing is recommended between age 9 and 11. Children who are considered overweight at age 4 and fail to lose weight to height after 6 months should be referred to a registered dietician.
The new guidelines recommend all kids be screened for high cholesterol, twice, before reaching age 21, regardless of risk factors. According to the report,: "Combined evidence from autopsy studies, vascular studies, and cohort studies strongly indicates that abnormal lipid levels in childhood are associated with increased evidence of atherosclerosis."
Children who don’t respond to dietary interventions and have close relatives with heart disease should be considered for cholesterol lowering medication therapy.
The authors of the report say heart disease risks should be tracked starting in childhood; into adulthood. The expert panel concludes checking cholesterol in kids and intervening when indicated will ensure better health in adulthood.