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Children with a family history of high cholesterol or early heart disease should be routinely screened, even if their weight is normal. They may have a genetic predisposition for excess cholesterol levels, known as “familial hypercholesterolemia” (FH). These kids have high levels of “bad cholesterol” (low-density lipoprotein, or LDL), beginning at birth. This can lead to early thickening of the artery walls, premature cardiovascular disease and an increased risk of early heart attack.  

FH is underestimated in both the community and pediatric medical practices. Children with FH have no signs or symptoms, and they often don’t fit the profile of someone at risk. They usually have a normal weight and healthy lifestyle/diet, but they generally have a family history of early heart disease. Children with a parent, grandparent, sibling, aunt or uncle with high cholesterol or a cardiac event before age 55 should be routinely monitored.  

Overweight or obese children should also have their cholesterol levels routinely screened, as they’re at increased risk of developing early heart disease.  

It’s important to differentiate between obese children with high cholesterol and those with FH, which is not traditionally associated with obesity. With today’s obesity epidemic, however, many children with FH are also overweight or obese.  

“Cholesterol levels in children who are obese usually respond well to diet and lifestyle modifications, whereas children with FH often need medications in addition to diet and exercise,” says Julie Brothers, MD, medical director of the Lipid Heart Clinic at The Children’s Hospital of Philadelphia. Dietary modifications and increased physical activity are the first-line treatments for children diagnosed with elevated cholesterol levels. Doctors may also recommend statin therapy (cholesterol-lowering drugs).  

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