18
Diagnosis
4.4.4. Primary Prevention in Other Age Groups
COR LOE
Recommendations
IIa B-NR 5. In children and adolescents found to have moderate or
severe hypercholesterolemia, it is reasonable to carry out
reverse-cascade screening of family members, which includes
cholesterol testing for first-, second-, and when possible,
third-degree biological relatives, for detection of familial
forms of hypercholesterolemia.
IIa C-LD 6. In children and adolescents with obesity or other metabolic
risk factors, it is reasonable to measure a fasting lipid profile
to detect lipid disorders as components of the metabolic
syndrome.
IIb B-NR 7. In children and adolescents without cardiovascular risk
factors or family history of early CVD, it may be reasonable
to measure a fasting lipid profile or nonfasting non HDL-C
once between the ages of 9 and 11 years, and again between
the ages of 17 and 21 years, to detect moderate to severe lipid
abnormalities.
a
Family history of early CVD is defined here as MI, documented angina, or atherosclerosis
by angiography in parents, siblings, grandparents, aunts, or uncles (<55 years of age for men,
<65 years of age for women).
b
TC ≥240 mg/dL (≥6.2 mmol/L), LDL-C ≥190 mg/dL (≥4.9 mmol/L), non–HDL-C
≥220 mg/dL (≥5.7 mmol/L), or known primary hypercholesterolemia.
Table 7. Normal and Abnormal Lipid Values in Childhood
a,b
Acceptable,
mg/dL
Borderline,
mg/dL
Abnormal,
mg/dL
TC <170 (<4.3 mmol) 170–199 (4.3–5.1 mmol) ≥200 (≥5.1 mmol)
Triglycerides
(0–9 y)
<75 (<0.8 mmol) 75–99 (0.8–1.1 mmol) ≥100 (≥1.1 mmol)
Triglycerides
(10–19 y)
<90 (<1.0 mmol) 90–129 (1.0–1.5 mmol) ≥130 (≥1.4 mmol)
HDL-C >45 (>1.2 mmol) 40–45 (1.0–1.2 mmol) <40 (<1.0 mmol)
LDL-C <110 (<2.8 mmol) 110–129 (2.8–3.3 mmol) ≥130 (≥3.4 mmol)
Non–HDL-C <120 (<3.1 mmol) 120–144 (3.1–3.7 mmol) ≥145 (≥3.7 mmol)
a
Values for plasma lipid and lipoprotein levels are from the NCEP Expert Panel on
Cholesterol Levels in Children. Non–HDL-C values from the Bogalusa Heart Study are
equivalent to the NCEP Pediatric Panel cutpoints for LDL-C.
b
e cutpoints for high and borderline high represent approximately the 95th and 75th
percentiles, respectively. Low cutpoints for HDL-C represent approximately the 10th
percentile.
