15
Children and Adolescents
Chart 5. Children and Adolescents
Recommendations
Strength Quality
Universal lipid screening of all children, regardless of general
health or the presence or absence of ASCVD risk factors, is
recommended between 9–11 years of age, with repeat lipid
screening at 20 years of age or earlier if dyslipidemia is present.
E Low
If a child or adolescent patient is screened and has a fasting or
non-fasting non-HDL-C level ≥145 mg/dL, then additional
follow-up is recommended. Two fasting lipid profiles should
be obtained and the results averaged for evaluation of the most
appropriate course of action.
E Low
Children ≥2 years of age with the following characteristics
should be screened for dyslipidemia:
• One or both biological parents are known to have
hypercholesterolemia or are receiving lipid- lowering medications
• Have a family history of premature ASCVD in an expanded
first degree pedigree (i.e., to include not only parents and
siblings, but also aunts, uncles, and grandparents) in men
<55 or women <65 years of age
• Consideration should also be given to screening for those in
whom family history is unknown (e.g., adopted)
B Moderate
Children should be regularly screened for major risk factors
and conditions associated with increased ASCVD risk, but
there are no validated methods for risk factor scoring in
patients <20 years of age.
B Moderate
Decisions on target levels during treatment are a matter of
clinical judgment, but age-appropriate, percentile-based
cutpoints from the 2011 Expert Panel on Integrated
Guidelines for Cardiovascular Health and Risk Reduction in
Children and Adolescents: National Heart, Lung, and Blood
Institute (http://www.nhlbi.nih.gov/health-pro/guidelines/
current/cardiovascular-health-pediatric-guidelines/summary)
should be considered as the upper limits for therapeutic
atherogenic cholesterol goal ranges for managing children and
adolescents:
• Non-HDL-C: 144 mg/dL
• LDL-C: 129 mg/dL
E Low
Î Although ASCVD events rarely occur in children, the risk factors and
risk behaviors that accelerate development of ASCVD are present in
childhood.
Î The presence and intensity of risk factors are highly correlated with the
extent and severity of atherosclerosis. The combined impact of multiple
risk factors is exponentially greater than individual factors alone.
Î Furthermore, risk factors measured in childhood and adolescence are
better predictors of the severity of atherosclerosis than risk factors
measured in young adults.
