Management of Hypercholesterolemia in Children and Adolescents

Initial Assessment and Goals

The optimal goal for LDL cholesterol in children and adolescents is <100 mg/dL, according to the American Diabetes Association 1, 2
Initial lipid testing should be performed at diagnosis and annually thereafter, as recommended by the American Diabetes Association 3
Target values for lipid profiles include LDL cholesterol <100 mg/dL, HDL cholesterol >35 mg/dL, and triglycerides <150 mg/dL, as suggested by the American Diabetes Association 3

Initial therapy should consist of medical nutrition therapy with specific parameters, including limiting calories from fat to 25-30% of total calories, limiting saturated fat to <7% of total calories, and limiting dietary cholesterol to <200 mg/day, as recommended by the American Diabetes Association 1, 2, 4
Increasing physical activity with emphasis on weight control if needed is also recommended, according to the American Diabetes Association 1, 2

If LDL cholesterol remains >130 mg/dL after 6 months of dietary intervention, statin therapy should be initiated, as recommended by the American Diabetes Association and other guidelines 3, 5
For pediatric patients aged 10 years and older with persistently elevated LDL >130 mg/dL despite dietary intervention, initiating statin therapy with a goal of LDL <100 mg/dL is recommended, according to the American Diabetes Association and other guidelines 5

Monitor lipid levels annually once the target is achieved, as recommended by the American Diabetes Association and other guidelines 5
If LDL cholesterol values are within the accepted risk level (<100 mg/dL), a lipid profile repeated every 3 years is reasonable, according to the American Diabetes Association 1
Assess for potential side effects of statin therapy at follow-up visits, as recommended by the American Diabetes Association and other guidelines 5

For females of childbearing potential, discussing contraception before initiating statin therapy due to potential teratogenic effects is recommended, according to the American Diabetes Association and other guidelines 1, 5
Statins are contraindicated in pregnancy, and prevention of unplanned pregnancies is of paramount importance, as recommended by the American Diabetes Association 1

Delaying pharmacologic treatment when appropriate criteria are met after lifestyle modification trial should be avoided, as recommended by the American Diabetes Association and other guidelines 5
Failing to screen for and address other cardiovascular risk factors should be avoided, according to the American Diabetes Association 4
Not providing adequate counseling regarding contraception for females of childbearing age when prescribing statins should be avoided, as recommended by the American Diabetes Association and other guidelines 1, 5
Discontinuing medication completely when side effects occur rather than adjusting dosage should be avoided, according to the American Diabetes Association and other guidelines 5