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

Advice from Boston Children's doctors on what to do when your teen has high cholesterol

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

Anxious parents

In 2011, the American Academy of Pediatrics has 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 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 (TGs) — should be kept below certain thresholds if possible. (Total cholesterol less than 170 mg/dl, LDL cholesterol less than 110 mg/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 teens with high LDL:

  • eat a diet low in saturated fat, 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

We recommend that teens with high TGs:

  • avoid sugar-sweetened beverages
  • make more of their grains whole grains

Everyone should:

  • 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. At 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.

In 2015, we conducted 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.

Unfortunately, some of our other research has shown that teenagers don’t always take the possibility of elevated cholesterol tests seriously, especially when the risk of future heart disease is still far off in the future. We are currently studying heart disease awareness among adolescents and young adults and finding that while awareness is still low, teens are eager to learn how to live their best and healthiest life now.

One of our other research studies found that a freely available online tool developed here at the Harvard TC Chan School of Public Health, the Healthy Heart Score, accurately predicts early heart disease events in young adults. Consider taking the Healthy Heart Score assessment together as a family, and come visit us if you have any concerns about your teen’s cholesterol or heart health.

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:

Dr. Holly Gooding offers her expertise on teens and cholesterol

Dr. Holly Gooding is a specialist in adolescent medicine at Boston Children’s.





Sarah De Ferranti offers her expertise on teens and cholesterolDr. Sarah deFerranti is director of Boston Children’s Preventive Cardiology Program.