Dr. Lisa Hudgins Answers Your Questions About Cholesterol Treatment

D.T. from Adkins, Tex., asked: My family has a history of high cholesterol. I recently insisted my son's doctor test his cholesterol. They treated me like I was the worst mother since we had to hold down my 3 year-old to take the blood. When the results came back, it said his was 178 with 101 being his bad cholesterol. When I later asked his doctor what we should do about it, they told me to not worry about it - it really meant nothing. They told me to take fat out of his diet. He has been on a high whole grain diet since he was started on solid foods as a baby. He is not overweight either. His test was done just last month. Now I am seeing information on this. Should I go back to his doctor to have him put on medication? Everyone in my family has needed medication to control it (mine was 224 in high school)- this is in spite of no weight problems. Please advise me to best actions for my son. He turned 4 this last month. Thanks

Dr. Hudgins answered: Your son's LDL cholesterol level is normal, and, assuming that his HDL and triglycerides are normal, no treatment is needed except the "heart-healthy" diet recommended for all kids older than 2 years and ample physical activity. Sometimes the labs flag LDL levels as high based on their own criteria. Because of family history, his fasting profile should be repeated every 3-5 years or after excessive gain in body weight.

Wendy from Minneapolis, Minn., asked: Our 6 year old daughter is adopted from Guatemala. We've no information on her medical history. At 5 she was tested for cholesterol, once with fasting, once without. The results were 215 and 225. These results are high for an adult, but I've no understanding of what is the appropriate level for a child. She is very physically active. Weighs 42 pounds and is approximately 45 inches tall. She eats a balanced diet. I'm concerned she may have genetically high cholesterol. What is the appropriate scale to use when measuring a child's cholesterol?

Dr. Hudgins answered: A full fasting lipid panel with LDL cholesterol ("bad cholesterol") and HDL cholesterol ("good cholesterol") is needed, since many children with slightly elevated total cholesterol levels have an elevated HDL cholesterol and a normal LDL cholesterol. If the complete lipid panel has not been done, it should be done after at least 3 months of better adherence to a cholesterol-lowering diet, preferably with help from a dietitian. If the LDL cholesterol is greater than 130 mg/dL, your daughter probably has a mild, genetic form of high cholesterol, but further lowering is still possible with dietary changes. Unless the HDL is extremely low, it is unlikely that the LDL will be high enough to consider statin therapy (>160 mg/dL) when she turns 7 or 8.

Dr. Lisa C. Hudgins, M.D., is pediatric director of The Rogosin Institute, a premier not-for-profit medical treatment and research institute in New York, and associate professor of pediatrics in medicine and pediatrics at Weill Medical College of Cornell University.

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