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Beginning in childhood, the waxy substance called cholesterol and other fatty substances known as lipids begin to build up in the arteries. Slowly, over many years, these build-ups harden into plaques that narrow the passageway. During adulthood, plaque buildup and resulting health problems occur not only in the arteries supplying blood to the heart muscle but in arteries throughout the body (a problem known as atherosclerosis). For both men and women in the United States, the number one cause of death is heart disease, and the amount of cholesterol in the blood greatly affects a person’s chances of suffering from it. Physical activity and healthy eating in childhood and adolescence—appropriately limiting unhealthy cholesterol, saturated fat, and trans fat—may protect against heart disease in adulthood.

For those under 20 years of age and at low risk, cholesterol testing is usually not ordered routinely. However, when a youth is at risk, a blood test to measure cholesterol levels may provide useful information.

Risk Factors

  • Family History: Cholesterol testing may be most appropriate for youths with a family history of high cholesterol or heart disease, particularly that occurring before age 55 in men or 65 in women. If the family history is not known, a cholesterol test is recommended, particularly if other risk factors are present.
  • Personal Health: Cholesterol testing is also recommended for youths judged to be at higher risk because:
    • they are overweight
    • they consume excessive amounts of saturated fats and cholesterol
    • they have diabetes or hypertension (high blood pressure)
    • they smoke.

When overweight or obese
Cholesterol testing is advised for overweight youths, when the individual’s body mass index (BMI) is at or above the 85th percentile. The BMI should be calculated at least once a year by the youth’s health care provider. For an obese youth (one whose BMI is at or above the 95th percentile), laboratory tests to measure cholesterol levels may be recommended every 2 years.

High-risk children should have their first cholesterol test before 10 years of age, according to the American Academy of Pediatrics, which recommends the fasting lipid profile. If the results are not worrisome, the fasting test should be given again in three to five years. The youth’s age and stage of puberty as well as ethnicity and gender must be considered as well. 

National Heart, Lung, and Blood Institute: What is high blood cholesterol?
Keep Kids Healthy: Cholesterol Screening
KidsHealth: Cholesterol and Your Child
The Children’s Hospital Boston: Cholesterol, LDL, HLD & Triglycerides


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