Cholesterol is a waxy, fatty substance that travels through the blood and is important for many functions in the body, including:
Helping to make hormones
Helping to make Vitamin D
Building cell membranes
Cholesterol is obtained from animal products that we eat. It’s also produced in our liver. The liver can make all the cholesterol that the body needs.
It’s important to have healthy levels of cholesterol.
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The recommended cholesterol levels¹ for teens are:
Total cholesterol: Less than 170 mg/dL (9.4 mmol/L)
Low density lipoprotein (LDL) cholesterol: Less than 100 mg/dL (5.55 mmol/L)
High density lipoprotein (HDL) cholesterol: More than 45 mg/dL (2.5 mmol/L)
When someone has high cholesterol, they have too much LDL cholesterol and/or not enough HDL cholesterol.
LDL cholesterol is known as “bad” cholesterol. Too much LDL in the bloodstream builds up in the arteries, hardening and blocking them. This makes it harder for the heart to pump blood around the body and increases the chance of:
HDL cholesterol is known as “good” cholesterol. It helps absorb and remove LDL cholesterol from the blood by carrying it back to the liver and flushing it from the body. It’s beneficial to have high HDL levels.
A survey² found that one in five children and adolescents had high total cholesterol, high non-HDL cholesterol, or low HDL cholesterol.
Among this population of teens, almost 9% aged 16–19 had high total cholesterol.
High cholesterol is more common in:
Teen girls than teen boys
Teens with obesity
Non-Hispanic black and non-Hispanic Asian teens
Older teens, aged 16 to 18
Several factors can contribute to high cholesterol in children and teens. These include:
Lifestyle has an important influence on cholesterol levels, such as:
Obesity or being overweight
Smoking or being exposed to second-hand smoke
A sedentary lifestyle
High cholesterol can be caused by an unhealthy diet, such as a diet high in:
Saturated fats (found in dairy products like butter and cheese, solid oils such as palm and coconut oil, and fatty meats like bacon, steak, and sausages)
Trans fats (found in fried and battered foods, stick margarine, and some baked and processed goods like cakes and pies)
In addition, high alcohol intake can increase your total cholesterol levels
Several medical conditions can cause or contribute to high cholesterol, such as:
A family history of high cholesterol, for example, the genetic condition called familial hypercholesterolemia (FH). If there is a concern about FH, the child will often be checked for high cholesterol from age two.
Untreated high cholesterol increases the chance of developing heart disease and heart attacks or strokes. Because of this, treating it as soon as it becomes apparent is important.
Lifestyle changes and medication are the two main ways to treat high cholesterol in teens.
Lifestyle changes are often the primary treatment³ for teens.
The teen doesn’t have to go through this alone. A healthy lifestyle benefits the whole family, and making changes together is a good way to support and encourage teens.
Healthy lifestyle changes include:
It’s recommended that teens get at least one hour of physical activity each day.
Aerobic exercises like biking, running, walking, and swimming are all good options, but physical activity doesn’t need to be high-intensity workouts. Simply reducing screen time and spending more time outdoors can help.
Increase the body’s production of HDL cholesterol
Reduce LDL cholesterol
Reduce body fat
Reduce one’s body mass index (BMI)
Making healthy food choices for high cholesterol involves focusing on a heart-healthy diet. This involves:
A balanced caloric intake⁴
Focusing on unsaturated fats and limiting foods high in saturated fats, trans fats, and cholesterol
Eating more lean meat, poultry, soy protein, and fish, rather than red meat
Eating an abundance of whole grains, fruits, and vegetables
Supplementing with plant sterols
Eating low-fat dairy products
Limiting highly processed and packaged foods
Limiting foods high in added sugar and salt
Baking or grilling foods, instead of frying them
Teens are growing so it’s not recommended that they follow a restrictive diet. One recommendation is to add healthy foods rather than completely cutting out unhealthy foods.
Teens who are overweight or obese may be encouraged to reach a healthy weight. This should be done under the guidance of a medical professional.
Medication for high cholesterol isn’t always needed.
Often, lifestyle changes are enough to achieve healthy cholesterol levels in teens. Other times, however, medications should be considered in addition to diet and exercise to further reduce cholesterol.
According to the American Academy of Pediatrics, children over the age of eight may be able to take cholesterol medications if:
Their LDL cholesterol is higher than 190 mg/dL (10.6 mmol/L) despite making lifestyle changes for six months
Their LDL cholesterol is at least 160 mg/dL (8.9 mmol/L), and they have a family history of early-onset cardiovascular disease, or they have other risk factors such as FH, obesity, and cigarette smoking
Their LDL cholesterol is higher than 130 mg/dL (7.2 mmol/L), and they have diabetes
Some medications used to treat teenagers are:
Statins are the first choice of medication for teens with high cholesterol.
The statins that have been approved by the Food and Drug Administration (FDA) for children with FH over the age of ten include:
Statins block the HMG-CoA enzyme that helps produce cholesterol. This leads to decreased LDL cholesterol production and increased LDL receptor production, so more of the remaining cholesterol is removed.
Statins don’t affect teens’ growth, puberty, or cognitive development. To be safe, however, female teens should wait a year after their first menstrual cycle.
Bile acid sequestrants reduce cholesterol on their own or when combined with a statin. These medications bind to bile acids in the stomach and remove them through your stool. The liver then uses cholesterol from the blood to produce more bile acids, which reduces your cholesterol levels.
Colesevelam (Welchol) is the only bile acid sequestrant that has been FDA approved for children over the age of ten with heterozygous FH. Although no longer a first-line treatment, it was the recommended option before statins had been researched for use in young people.
Studies⁵ have found bile acid sequestrants effective for adolescents, but some concerns around palatability and tolerance have been raised.
Ezetimibe (Zetia) is approved for children with heterozygous FH over the age of ten. It can be taken alongside statins or on its own.
Ezetimibe prevents cholesterol from being absorbed into the small intestine. This leads to a reduction in the liver’s cholesterol stores and an increased cholesterol clearance from the blood.
PCSK9 inhibitors stop the PCSK9 protein from breaking down LDL receptors. By doing so, more LDL cholesterol can be removed from the blood through these receptors.
Not all PCSK9 inhibitors are recommended for children and teens.
However, evolocumab (Repatha) has been FDA approved for patients with homozygous FH aged 13 years or older.
It’s recommended to identify children with abnormal cholesterol values between the ages of nine and 11, that is before they become a teenager.
If a family history of high cholesterol, heart attacks, or strokes exists, cholesterol testing may begin from the age of two. Upon reaching adolescence, your teen should see a doctor and have a blood test for cholesterol levels every five years.
It can be worrying to discover that your teen has high cholesterol. Fortunately, safe and effective steps are available for teens, which their families can help with, to bring their cholesterol levels under control to protect their current and future health.
High cholesterol in children and teens | MedlinePlus
Abnormal cholesterol among children and adolescents in the United States, 2011–2014 | Centers for Disease Control and Prevention
Use of lipid lowering medications in youth | NIH: National Library of Medicine
Cholesterol | Teens Health
High cholesterol in teens: Care instructions | My Health Alberta.ca
High cholesterol in teens, early 20s leads to heart problems by middle age | NIH: National Heart, Lung, and Blood Institute
Teen with high cholesterol gets healthy with help from family pediatrician | Health: University of Utah
LDL: The "Bad" cholesterol | MedlinePlus
Facts about saturated fats | MedlinePlus