High Cholesterol In Teens: What You Need To Know

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.

High cholesterol in teens

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: 

• Heart attacks

• Strokes

• Cardiovascular disease

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.

How common is high cholesterol in teens?

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

What causes high cholesterol in children and teens?

Several factors can contribute to high cholesterol in children and teens. These include:

Lifestyle

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

Diet

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

Pre-existing medical conditions

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.

• Diabetes

• Kidney disease

• Underactive thyroid

Cholesterol treatments for teens

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

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:

Exercise 

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.

Exercise can:

• Increase the body’s production of HDL cholesterol

• Reduce LDL cholesterol

• Reduce body fat

• Reduce one’s body mass index (BMI)

Diet

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.

Weight management

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

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

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:

• Simvastatin (Zocor)

• Atorvastatin (Lipitor)

• Pravastatin (Pravachol)

• Fluvastatin (Lescol)

• Rosuvastatin (Crestor)

• Lovastatin (Mevacor)

• Pitavastatin (Livalo)

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

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

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

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.

When should a teen be taken to a doctor?

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.

The lowdown

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.