Version July 2025
AS: aortic stenosis; ASCVD: atherosclerotic cardiovascular disease; CoA: coarctation of the aorta; FH: familial hypercholesterolemia; HCM: hypertrophic cardiomyopathy; HDL-C: high-density lipoprotein cholesterol; HIV: human immunodeficiency virus; JIA: juvenile idiopathic arthritis; LDL-C: low-density lipoprotein cholesterol; SLE: systemic lupus erythematosus; TGA: transposition of the great arteries.
* For children with underlying risk factors for premature ASCVD (listed below)Δ, lipid screening begins at the time the risk factor is first identified (generally not earlier than age 2 years) with subsequent testing every 1 to 3 years depending on the nature of the risk factor(s). For children without underlying risk factors for premature ASCVD, routine lipid screening is performed twice during childhood: once before puberty (age 9 to 11 years) and once after puberty (age 17 to 21 years). Refer to UpToDate topic on dyslipidemia screening in children for additional details.
¶ Lifestyle modifications may include low saturated fat diet; increased intake of dietary fiber through fruits, vegetables, and whole grains; supplementation with plant stanols and sterols; increasing physical activity; and, in children with obesity, weight loss. Refer to UpToDate topic on management of dyslipidemia and obesity in children and adolescents for further details.
Δ Risk factors for premature ASCVD in children are similar to those in adults and include hypertension, diabetes, obesity, smoking/smoke exposure, and family history of premature ASCVD. In addition, other medical conditions that can present during childhood and that are associated with increased risk of early ASCVD include chronic kidney disease, Kawasaki disease, childhood cancer, transplant vasculopathy, chronic inflammatory diseases (eg, SLE and systemic JIA), HIV, certain congenital heart disease defects (CoA, AS, TGA, congenital coronary artery anomalies), cardiomyopathy (eg, HCM), and adolescent depressive and bipolar disorders.
◊ Confirmatory testing consists of 2 fasting lipid profiles obtained 2 weeks to 3 months apart. If the patient had a fasting lipid profile performed as the initial screen, a second fasting lipid profile is obtained 2 weeks to 3 months later; if the patient's initial screen was performed using nonfasting non-HDL-C, 2 separate fasting lipid profiles should be performed. Average the 2 results.
§ For details regarding lipid-lowering drug therapy, including indications for starting lipid-lowering drug therapy in children and adolescents with elevated LDL-C and/or FH, refer to separate UpToDate topics on management of pediatric dyslipidemia and FH.
¥ Secondary causes of hypercholesterolemia include diabetes mellitus, nephrotic syndrome, hypothyroidism, pregnancy, hepatic disease, and certain medications (eg, glucocorticoids, antiretrovirals). Refer to the UpToDate topic on screening and diagnosis of dyslipidemia in children for further details.
