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Blood Cholesterol

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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.

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