Cholesterol and Atherosclerosis in Children

AHA Scientific Position

There is compelling evidence that the atherosclerosis (ath"er-o-skleh-RO'sis) (fatty deposits of plaque in artery walls) or its precursors begins in childhood and progresses slowly into adulthood. Then it often leads to coronary heart disease, the single largest cause of death in the United States. Furthermore, there is evidence that

* Elevated cholesterol levels early in life may play a role in the development of atherosclerosis in adults.
* Eating patterns and genetics affect blood cholesterol levels and coronary heart disease risk.
* Lowering levels in children and adolescents may be beneficial.

Many laboratory, clinical, pathological and epidemiological studies have clearly established that high blood cholesterol levels play a role in developing coronary heart disease in adults. Several studies also have shown that fatty buildups in arteries begin in childhood and are more likely with higher blood cholesterol levels.

To reduce fatty buildups in arteries in children (and adults):

* Cigarette smoking should be discouraged.
* Regular aerobic exercise that lasts at least 30–60 minutes on most days of the week should be encouraged.
* High blood pressure should be identified and treated.
* Obesity should be avoided or reduced.
* Diabetes mellitus (di"ah-BE'teez or di"ah-BE'tis meh-LI'tis) should be diagnosed and treated.

Children age 2 years and older 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. Doing this will help them maintain normal blood cholesterol levels and promote cardiovascular health.

Cholesterol levels in children and adolescents 2–19 years old

Category	Total Cholesterol (mg/dL)	LDL Cholesterol (mg/dL)
Acceptable	less than 170	less than 110
Borderline	170–199	110–129
High	200 or greater	130 or greater

HDL levels should be greater than or equal to 35 mg/dL and triglycerides should be less than or equal to 150 mg/dL

The American Heart Association endorses these guidelines of the National Cholesterol Education Program's Expert Panel on Blood Cholesterol in Children and Adolescents.

NIH Parents' Guide: National Cholesterol Education Program; U.S. Department of Health and Human Services; National Institute of Health, National Heart, Lung, and Blood Institute, NIH Publications, No. 93-3102, September 1993