Management of Dyslipidemia in Adolescents

Initial Assessment and Goals

• The American Diabetes Association recommends a HDL cholesterol goal of >35 mg/dL for adolescents 1, 2, 3
• The American Heart Association recommends a triglycerides goal of <150 mg/dL for adolescents 1, 2, 3
• The American College of Cardiology recommends a LDL cholesterol goal of <100 mg/dL for adolescents 1, 3

First-Line Treatment: Intensive Lifestyle Modification

• The American Diabetes Association recommends limiting total fat intake to 25-30% of total calories for adolescents with dyslipidemia 1, 3
• The American Heart Association recommends restricting saturated fat to <7% of total calories for adolescents with dyslipidemia 1, 2, 3
• The American College of Cardiology recommends completely eliminating trans fats from the diet of adolescents with dyslipidemia 1, 3
• The American Diabetes Association recommends decreasing simple sugar intake significantly for adolescents with dyslipidemia 1, 3
• The American Heart Association recommends increasing dietary omega-3 fatty acids for adolescents with dyslipidemia 1, 3

Monitoring Strategy

• The American Diabetes Association recommends obtaining a fasting lipid panel after achieving initial glycemic control for adolescents with dyslipidemia 1, 3
• The American College of Cardiology recommends screening for secondary causes of dyslipidemia, including thyroid function tests, liver function tests, and renal function tests 1, 2, 3, 5

When to Consider Pharmacologic Therapy

• The American College of Cardiology recommends initiating statin therapy if LDL cholesterol remains >130 mg/dL after 6 months of intensive dietary intervention for adolescents with dyslipidemia 1, 2, 3
• The American Heart Association recommends considering pharmacologic therapy for adolescents with LDL ≥190 mg/dL with no other cardiovascular risk factors 2
• The American College of Cardiology recommends considering pharmacologic therapy for adolescents with LDL ≥160 mg/dL with other risk factors present 2

Special Considerations for This Age Group

• The American Diabetes Association recommends evaluating for additional metabolic syndrome components, including blood pressure measurement, fasting glucose, and HbA1c for adolescents with dyslipidemia 1, 3, 6
• The American College of Cardiology recommends assessing social context, including food insecurity, housing stability, and financial barriers for adolescents with dyslipidemia 1