67
4.2.8.1. Children and Adolescents
COR LOE
Recommendations
1 B-R
1. In children and adolescents with lipid abnormalities, lifestyle
management is recommended to improve LDL-C, TG, and
non–HDL-C.
1 B-R
2. In children and adolescents ≥8 years of age with an LDL-C
level persistently ≥160 mg/dL (4.1 mmol/L) and a presentation
consistent with FH who do not respond sufficiently after 3 to 6
months of lifestyle management, initiation of statin and other
LLT as necessary is recommended to lower LDL-C.*
2a B-NR
3. In children and adolescents with a clinical presentation
consistent with FH, panel-based genetic testing for
pathogenic/likely pathogenic rare variants for FH can be
useful to guide diagnosis, cascade testing, and treatment.
* Children with HoFH require specialized consideration, including aggressive LLT at the
time of diagnosis, including in infancy (Section 4.2.4.4, "Severe Hypercholesterolemia with
Clinical or Genetic Confirmation of Homozygous Familial Hypercholesterolemia [HoFH]").
4.2.8. Considerations in Patient Management
Table 18. Normal and Elevated Lipid Values in Childhood*
Acceptable, mg/dL Borderline, mg/dL Abnormal, mg/dL
TC <170 mg/dL 170–199 mg/dL ≥200 mg/dL
TG: 0–9 y <75 mg/dL 75–99 mg/dL
≥100 mg/dL
TG: 10–19 y
<90 mg/dL 90–129 mg/dL
≥130 mg/dL
HDL-C
>45 mg/dL 40–45 mg/dL
<40 mg/dL
LDL-C
<110 mg/dL 110–129 mg/dL
≥130 mg/dL
Non–HDL-C
<120 mg/dL 120–144 mg/dL ≥145 mg/dL
* Values for plasma lipid and lipoprotein levels are from the National Cholesterol Education
Program Expert Panel on Cholesterol Levels in Children; non–HDL-C values equivalent
to LDL-C are taken from the Bogalusa Heart Study. 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.
Values given are in mg/dL. To convert to SI units, divide the results for TC, LDL-C, HDL-C,
and non–HDL-C by 38.6; for TG, divide by 88.6.
HDL-C indicates high-density lipoprotein-cholesterol; LDL-C, low-density lipoprotein-
cholesterol; SI, Système international d'unités (International System of Units); TC, total
cholesterol; and TG, triglyceride.
Modified with permission from Grundy et al. Copyright © 2018 American Heart Association,
Inc. and American College of Cardiolog y Foundation.
