Overview of management of hypercholesterolemia in children 10 years and older
Overview of management of hypercholesterolemia in children 10 years and older
This algorithm summarizes the management of children ≥10 years old with LDL-C levels in the range of 130 to 249 mg/dL (3.4 to 6.5 mmol/L). Initial treatment decisions should be based on averaging the LDL-C values from two separate fasting lipid profiles obtained 2 weeks to 3 months apart. Children <10 years old with clinically significant hypercholesterolemia and pediatric patients with LDL-C ≥250 mg/dL (≥6.5 mm/L) should generally be referred to a pediatric lipid specialist. This algorithm is intended for use in conjunction with additional UpToDate content on dyslipidemia in children. Refer to UpToDate topics on the management of dyslipidemia in children for additional details of our approach to treatment and the overall efficacy of these treatments. LDL-C units are mg/dL; divide by 38.67 to convert to mmol/L.
CVD: cardiovascular disease; LDL-C; low density lipoprotein cholesterol; FH: familial hypercholesterolemia; BMI: body mass index; NAFLD: nonalcoholic fatty liver disease; PCOS: polycystic ovary syndrome; TC: total cholesterol; SLE: systemic lupus erythematosus; JIA: juvenile idiopathic arthritis; HCM: hypertrophic cardiomyopathy; TGA: transposition of the great arteries; BP: blood pressure. * Lifestyle changes include:
Diet modification (encourage a heart-healthy diet that is low in saturated fats, devoid of trans fat, and high in fruits, vegetables, and whole grains)
Physical activity (encourage at least 1 hour/day of moderate to vigorous activity; limit nonacademic screen time to about 1 hour per day)
Weight loss in obese children
Avoidance of nicotine exposure
Consultation with a registered dietician is advised for implementation of dietary changes. For additional details, refer to separate UpToDate's content on pediatric dyslipidemia. ¶ For details on initiating, monitoring, and titrating statin therapy in children, refer to separate UpToDate content on management of pediatric dyslipidemia. Δ Family history of premature CVD is generally defined as heart attack, treated angina, interventions for coronary artery disease, sudden cardiac death, or ischemic stroke in a first-degree relative (parent or sibling) before age 55 (males) or 65 (females).
