Clinical Reference Systems: Pediatric Advisor 10.0
Cholesterol Screening or Testing (for Teenagers)
THE IMPORTANCE OF LOW CHOLESTEROL
Everyone needs to have some cholesterol in their blood.
Cholesterol is the normal way fat is carried in the
bloodstream. However, people who have higher-than-normal
levels of cholesterol have a greater risk of developing
coronary heart disease (CHD). If they lower their
cholesterol levels, they reduce their chances of having
heart disease. A 1-percent decrease in blood cholesterol
leads to a 2-percent decrease in the risk of CHD in adults.
One major goal of preventive medicine is to lower high
cholesterol levels to healthy levels.
The amount of cholesterol and saturated fats we eat affects
the level of cholesterol in our blood. If we eat less
cholesterol and saturated fat, we will have less cholesterol
in our blood.
Many children and teenagers who have high cholesterol
continue to have high cholesterol when they are adults.
Teenagers who reduce their cholesterol levels with proper
diet and exercise may have a better chance of having low
cholesterol when they are adults.
TYPES OF CHOLESTEROL
Cholesterol has several components: high-density
lipoproteins (HDL), low-density lipoproteins (LDL), and
triglycerides. All of these components combined are called
"total cholesterol." The HDL component is called the "good"
cholesterol because it carries cholesterol away from the
arteries to the liver. The liver helps the body get rid of
cholesterol. LDL is called the "bad cholesterol." If you
have too much LDL, the LDL leaves cholesterol on the inner
walls of the arteries. As a result your arteries become
So, in addition to reducing total cholesterol levels, it is
helpful to increase the HDL and decrease the LDL in the
blood. A 1-percent rise in HDL may give adults a 3-percent
decrease in the risk of coronary heart disease.
NORMAL AND ABNORMAL CHOLESTEROL LEVELS
Normal levels of total cholesterol in adolescents are
between 120 and 170 mg/dl. After age 18, the levels
considered to be normal rise about 1 point per year of age.
A healthy level of total cholesterol is below the 75th
percentile. For adolescents this means a cholesterol level
below 170 mg/dl. (The level of cholesterol in adults should
be below 200 mg/dl.) Levels between the 75th and 95th
percentiles are considered to be borderline high. Levels
above the 95th percentile (higher than 200 mg/dl in
adolescents and 240 mg/dl in adults) are high and abnormal.
In general, anyone who has a total cholesterol above the
75th percentile should try to lower it.
Levels of HDL, which we want to be high, should be above the
25th percentile (over 45 mg/dl in adolescents and over
40 mg/dl in adults). A borderline low value is between the
5th and 25th percentiles. A low or abnormal value is below
the 5th percentile (less than 35 mg/dl in adolescents,
30 mg/dl in adults).
TESTING THE CHOLESTEROL LEVELS IN CHILDREN AND TEENAGERS
The American Academy of Pediatrics and the American Heart
Association agree that all children and teenagers who are at
high risk for coronary heart disease should be screened.
A person is at high risk of developing CHD as an adult if
members of the family have had high blood cholesterol or
early coronary heart disease. Family members include
parents, grandparents, aunts, or uncles. A history of early
coronary heart disease includes heart attack, angina,
stroke, or bypass surgery that occurs in men less than 50
years old or women less than 60 years old. The information
about grandparents is important because other relatives
might not yet be old enough to have developed heart disease.
RETESTING TEENAGERS WITH HIGH CHOLESTEROL LEVELS
If your cholesterol is borderline high or high, it will be
checked again one to two weeks after the first test.
Cholesterol levels do vary somewhat day to day, so it is
important to confirm that the cholesterol is high.
Teenagers with confirmed high total cholesterol (greater
than the 95th percentile) will then have blood drawn for a
lipid profile or panel. This test measures the levels of
LDL, HDL, and triglycerides, as well as total cholesterol.
Diet and exercise treatment will start and the level of
cholesterol will be checked again in about 2 to 4 months.
If your total cholesterol level is borderline high (between
the 75th and 95th percentiles), diet and exercise treatment
can start without the lipid panel. Your total cholesterol
will probably be rechecked every year.
Lipid panels are not done for all people because they cost
much more than the total cholesterol test.
RETESTING TEENAGERS WITH NORMAL CHOLESTEROL LEVELS
Most physicians check the total cholesterol level of
teenagers and adults every 5 years as long as it remains in
the normal range.
TESTING FAMILY MEMBERS
If you have a high cholesterol (higher than 95th
percentile), we recommend that everyone in your family have
their total cholesterol checked. Very often the close
relatives of teenagers with high cholesterol also have high
cholesterol. Discovering that other family members have
high cholesterol will encourage your entire family to start
a healthier diet and exercise program.
For information on the treatment of high cholesterol, see
Treating High Cholesterol Levels.