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'Just for Teens' Cholesterol Analysis

New System Could Help Spot Risk for Future Heart Disease
By
WebMD Health News
Reviewed by Louise Chang, MD

Aug. 29, 2006 - A new system for interpreting cholesterol levels in teens could help better identify those at risk for heart disease as adults, researchers say.

Unlike the current guidelines, the proposed classification system factors in an adolescent's age and gender when determining normal and abnormal cholesterol levels.

This is important, says a researcher who developed the new system, because cholesterol levels are known to change greatly with normal growth, and they also differ by gender prior to adulthood.

"With the current system, very, very few young children would be considered at risk, even if they have very high cholesterol values for their age," Ian Janssen, PhD, tells WebMD. "And girls mature much earlier than boys. So at age 12 or 13, we might see different values in females than in males."

Early Predictor

Pediatricians do not routinely test cholesterol levels in children and teens, and adolescents are rarely put on cholesterol-lowering drugs because they have a low risk for heart disease.

But it is increasingly clear that the buildup of fatty plaque in the arteries that leads to heart disease can begin in childhood, Janssen says.

Current U.S. guidelines, in place since the early 1990s, have the same thresholds for identifying abnormal cholesterol and triglyceride levels for all children and teens between the ages of 2 and 19.

To create the new classification system, Janssen and colleague Courtney Jolliffe, MSc, of Ontario's Queen's University, Kingston, examined data from the U.S. National Health and Nutrition Examination Surveys (NHANES) collected between 1988 and 2002.

They looked at total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol, and triglyceride measurements for some 6,000 study participants between the ages of 12 and 20 to develop age- and gender-specific growth curves, similar to those used to monitor height and weight.

The New System

Under the new classification, a 12-year-old boy's total cholesterol level would be considered high at 233 mg/dL or greater, while the corresponding numbers for 15- and 19-year-old males would be 220 mg/dL and 238 mg/dL, respectively.

A 12-year-old girl's total cholesterol would be considered high at 211 mg/dL or greater, as would a 15-year-old's. The problem number for a 19-year-old female would be 238 mg/dL or above.

The report is published in the upcoming issue of the American Heart Association journal, Circulation.

At-Risk Kids Need Screening

Janssen makes it clear he does not think all children and teens need to have their cholesterol checked. But screening could help predict future risk in children with a strong family history of early heart disease or who have other risk factors for future heart disease, such as obesity, diabetes, and high blood pressure.

In this group of children, cholesterol screening using the new classification may help identify those at future risk better than measuring blood pressure and body mass index alone, he says.

American Heart Association spokesman Roger Blumenthal, MD, tells WebMD the new classification may give doctors more ammunition to motivate at-risk teens to make the dietary and lifestyle changes that could help them avoid future heart disease.

It could also give doctors a better idea of which patients might need to be placed on cholesterol-lowering statin drugs in their early 20s, he says.

Blumenthal directs the Johns Hopkins Ciccarone Preventive Cardiology Center in Baltimore.

"This should give us a better idea of what normal [cholesterol and triglyceride] levels are for teenagers," he says. "Physicians can use this information to help their patients better understand their risks."

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Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is optimal.

Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is near optimal.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is borderline high. If your LDL goes higher, your total cholesterol level could become Borderline High. Consider reducing the amount of foods you eat with saturated fats and increasing physical activity. If you get more exercise, your level of "good" HDL cholesterol may increase, which could also help to keep your levels of LDL and total cholesterol in check.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL. The HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is Very High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL because the HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is Borderline High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. But your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol is High, but your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol is High, but your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is Borderline High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe medication, such as statins. Following medication, dietary, and exercise instructions should result in improvements.

Your total cholesterol level is High, and your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe statins or other cholesterol-lowering medications.

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