High cholesterol (hyperlipidemia)

What is cholesterol?

Cholesterol (say: ko-LESS-ter-ol) 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 bodies, which produce it naturally, 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.

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 (say: HI-per-lip-id-EE-me-uh) refers to high cholesterol levels in the blood. It is also called hypercholesterolemia. In adults, it is mainly caused by inherited risk factors and a diet too high in fat.

Hyperlipidemia in children is not the same as it is in adults. It is usually passed from parent to child (familial hyperlipidemia). In a very few cases, given the increasing trend toward obesity among children, it is possible to see cases of hyperlipidemia caused by poor diet. Certain medications can also cause hyperlipidemia in some cases.

Hyperlipidemia is rare in children

About one in 500 children have the defective gene responsible for hyperlipidemia. This gene causes extremely high cholesterol or high triglycerides, another type of lipid. Children who inherit the defective gene from both parents are at even higher risk for heart problems.

Hyperlipidemia is diagnosed with a blood test

If the parents have a family history of high cholesterol and heart disease, doctors can test the cholesterol levels of babies while they are still in the womb. Or they can test the child very early in life.

What is an acceptable cholesterol level?

An acceptable total cholesterol level in a child or teen is less than 4.4 mmol/L (millimoles per liter of blood), with an LDL of less than 2.8 mmol/L.

Hyperlipidemia is managed with diet, exercise and medication

Lowering cholesterol levels in children and teens can help protect against heart disease. This can be done through diet, exercise and medication.

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 will need medication, often a combination of drugs. Examples of medication used include statins, bile acid resins and niacin. 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.

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.

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.