Dr. Lisa Hudgins Answers Your Questions About Cholesterol Treatment

July 8, 2008— -- Faith from Conroe, Texas, asked: My 8-year-old son, who is thin and very active, just had his cholesterol tested. His number was 204. The doctor wants him to be on a special diet. What is considered high cholesterol in children? Thank you.

Dr. Hudgins answered: Cholesterol levels in childhood are lower than adulthood. A cholesterol level greater than 200 mg/dL might be too high in a child 2-18 years of age. However, a full lipid panel with LDL cholesterol ("bad cholesterol") and HDL cholesterol ("good cholesterol") is needed, since the LDL clogs the arteries, whereas the HDL prevents the clogging. Many children with slightly elevated total cholesterol levels have an elevated HDL cholesterol and a normal LDL cholesterol. If the LDL cholesterol is greater than 130 mg/dL, he should make a greater attempt to follow a cholesterol-lowering diet, preferably with the help of a dietitian. All children from age 2 on should consume heart-healthy diets.

Lucy from Boulder, Colo., asked: My daughter was diagnosed with high cholesterol four years ago. She is now 9. At the time when we went to a pediatric cardiologist he recommended just monitoring her since she does not have any other risk factors (e.g., obesity, high blood pressure). Her diet is also pretty good. Her favorite food is corn! With AAP's recommendations, I am unclear as to if she would be a candidate for cholesterol lowering drugs. I am reluctant to start her up given the known (and unknown) side effects on children. Given she has no other risk factors, would you recommend her going on these drugs? What questions should I be asking our doctors?

Dr. Hudgins answered: I agree with the AAP recommendation that an LDL cholesterol level greater than 190 mg/dL on several occasions after optimal diet and physical activity in a child at least 8 years of age be treated with a statin. It should be emphasized that only a small number of children have cholesterol levels high enough to warrant statin therapy. Most will have one parent with a very high cholesterol (often greater than 300 mg/dL and heart disease). This genetic disorder, monogenic familial hypercholesterolemia, should be treated with a statin as early as age 7 or 8 given the rapid buildup of cholesterol in the arteries in childhood and high chance of a heart attack in early adulthood. If your daughter's LDL cholesterol level is higher than 160 mg/dL, be sure that you and her father know your lipid profiles! If your levels are normal and her levels are very high (LDL> 160 mg/dL), then a lipid specialist is needed to exclude rare disorders such as sitosterolemia.

Beth from Virginia Beach, Va., asked: Both of my children were diagnosed with high cholesterol at age 4. They were tested because of a family history. What have studies shown in regards to statin drugs affects on children's livers? This seems to be a consistent problem in adults. Shouldn't we be even more concerned with children?

Dr. Hudgins answered: There are four published and properly conducted studies of four different statins in 706 children ages 8 to 18 with LDL cholesterol levels of at least 160 mg/dL treated with drug or placebo for 1-2 years. There were no serious side effects, including effects on the liver. Four children had temporary elevations in liver function tests that went away after stopping the drug. In adults, serious problems in the liver are rare and reversible upon stopping the medicine. Since children are less likely to take other medications and to drink alcohol, they are probably at a lower risk of liver problems. Nevertheless, while on a statin, they should have a blood test for liver function every 4-6 months or if they develop persistent or severe nausea, vomiting and/or pain over the liver.