Middle aged adults are the focus of most cholesterol research and recommendations. After all, they are the ones just entering the high-risk phase of life for coronary artery disease. But should lipids be a concern for children and older adults? Yes.Children. The process of developing atherosclerosis begins early in life, butusually it becomes severe enough to cause problems only later in life. Evidence suggests that high cholesterol levels in childhood promote an earlier development of atherosclerosis and, by extension, increase the chances for development of coronary artery disease in adulthood.However, the evidence is not clear enough to justify recommending cholesterol tests for all children. Certainly children older than 2 who come from “high-risk” families—one parent has a cholesterol level of 240 mg/dl or higher or a parent or grandparent had evidence of coronary artery disease before age 55—should have their blood cholesterol measured. (See Cholesterol levels in children and adolescents from high-risk families, this page, for an interpretation of test results.)If a child’s cholesterol value is elevated, dietary changes are the first course of action. Actually, all children older than 2, regardless of whether a cholesterol level is known, should follow the same eating strategies that are recommended for adults. These strategies focus on reducing fat and cholesterol in the diet, maintaining a healthful weight, and encouraging physical activity. If by 10 years of age a child’s cholesterol level remains elevated above 190 mg/dl (or above 1 70 mg/dl in children from high-risk families) despite the best dietary attempts, then one of the lipid-lowering medications may be required. Not every medication is suitable for children, however, so the pediatrician will prescribe the appropriate one.*247\252\8*
