Children with high low-density lipoprotein (LDL) cholesterol levels should be reexamined before dietary or drug treatment is considered. A 2008 report from the American Academy of Pediatrics recommended dietary or drug intervention for teens with high cholesterol levels and other atherosclerosis risk factors, yet no studies had examined whether high LDL cholesterol levels in children and teens persist. Now a study has found that many children with extremely high LDL cholesterol levels (>= 160 or >= 190 mg/dL) have significantly lower levels when they're rechecked an average of three years later.

Figure. Patricia Miranda and her son Joshua, 8, prepare dinner at home in Oakland, California. When Miranda's oldest son, Eduardo, was told he was overweight and diagnosed with high cholesterol at age 5, she knew the family's eating habits had to change. Photo by Dean Coppola /

Freedman and colleagues evaluated data on 6,827 Bogalusa Heart Study participants who had LDL cholesterol levels measured an average of five times over a 20-year period. Levels of LDL cholesterol tended to decrease when children were 10 to 15 years old, then increase during adulthood. However, children who had the highest LDL cholesterol levels had significantly lower levels at the next examination. Upon reexamination, LDL cholesterol levels were, on average, 34 mg/dL lower in children with initial levels of 190 mg/dL or higher, and 21 mg/dL lower in children with levels between 160 and 189 mg/dL. By contrast, those with initially low LDL cholesterol levels (< 70 mg/dL) had levels a mean of 13 mg/dL higher at the next examination. Providers "should understand that multiple determinations may be needed to characterize a child's true LDL cholesterol status, particularly if levels are >= 160 mg/dL," write the authors.

"This study shows that laboratory measurements can change over time," says study coauthor Gerald S. Berenson, director of Tulane University's Center for Cardiovascular Health and the Bogalusa Heart Study. Nonetheless, "nurses need to look at the total picture and not focus on one single factor," he cautions. He recommends paying particular attention to children whose parents have a history of heart disease, diabetes, or hypertension. Berenson also advocates general screening for all children, using height, weight, body mass index, blood pressure, and lipoprotein measurements to establish risk profiles. "But you don't need to measure all lipids and lipoproteins. Total cholesterol, triglycerides, and high-density lipoprotein are enough," he says.-Carol Potera