Ask the expert: how to handle teen’s high cholesterol

Holly Gooding, MD, MSc
Holly Gooding, MD, MSc

Our pediatrician checked my teenager’s cholesterol and it came back high. What should we do?


Anxious parents


In 2011, the American Academy of Pediatrics recommended routine cholesterol screening for all young people ages 9-11 and 17-21 years. Since then, we have seen many more young people screened for cholesterol problems, although overall screening rates remain low. Cholesterol is an important part of heart health, along with having a healthy diet, exercise, weight, blood pressure, blood sugar and avoiding all tobacco products. When doctors check cholesterol, it is important to think about all of these healthy heart factors.

The 2011 Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents recommend this overall heart healthy approach and give specific recommendations for high cholesterol.

Cholesterol serves an important function in our body, and not all high cholesterol is bad. In fact, we want the high-density lipoprotein (HDL) cholesterol, or “healthy” cholesterol, to be high (greater than 45 mg/dl is best). But the other cholesterol values—total cholesterol, low-density lipoprotein (LDL)-cholesterol and triglycerides—should be kept below certain thresholds if possible. (Total cholesterol less than 170 mg/dl, LDL cholesterol less than 110mg/dl, and triglycerides less than 90 mg/dl are best.)

Most young people with high LDL cholesterol and high triglycerides are best treated with diet and exercise changes. We recommend that these teens:

  • eat a diet low in saturated fat (less than 7 percent of total calories), substituting in healthy fats like olive oil
  • eat less fatty red meats and eat more fish
  • avoid transfats that are found in some packaged foods
  • limit cholesterol intake to less than 200mg per day
  • avoid sugar-sweetened beverages
  • get one hour per day of moderate to vigorous physical activity
  • limit screen time to less than two hours daily
  • eat lots of fruits and vegetables, more than 5 per day

Some young people with very high LDL cholesterol levels may need a cholesterol-lowering drug. We typically prescribe drugs called statins for this problem. What LDL cholesterol level to consider drug therapy for depends on the number and type of other heart health factors the young person has and how old they are.

We recently did a research study comparing the pediatric and adult guidelines for treatment of high LDL cholesterol levels with statin drugs.  Both sets of guidelines agree that young people with an LDL cholesterol of greater than 190 mg/dl should be offered statin drugs, because they probably have a genetic problem that leads to very high cholesterol and early heart disease. Interestingly, the pediatric guidelines actually recommend treatment at lower LDL cholesterol levels (130 or 160 mg/dl) compared to the adult guidelines if other unhealthy heart factors are present. This is because the pediatric guidelines take more of an overall heart health and life course approach.

Learn more about Boston Children’s Preventive Cardiology Clinic, which helps patients and families understand cholesterol results and find the right treatment.

About the bloggers:

Holly Gooding, MD, MSc, is a specialist in adolescent medicine at Boston Children’s.

Sarah deFerranti, MD, MPH, is director of Boston Children’s Preventive Cardiology Program.