A “risk factor” is a condition, behavior, or anything about a person that makes that person more likely than the general population to get a disease.
- too much LDL (low-density lipoprotein): This type of cholesterol is commonly known as “bad” cholesterol because it builds up in the blood vessels, causing them to stiffen and narrow. For information on how high LDL is diagnosed and treated, see Cholesterol and Triglycerides.
- not enough HDL (high-density lipoprotein): HDL is “good” cholesterol—it helps to lower LDL. HDL cleans up LDL from the blood vessels and moves it to the liver, where it gets broken down and eliminated from the body through the digestive tract. High levels of HDL generally helps to counteract the effects of high LDL. For more information on how HDL can be increased, see Cholesterol and Triglycerides.
- triglycerides too high: Triglycerides are a class of fat found in the bloodstream that makes up the bulk of total body fat. Some experts believe high levels of triglycerides are a risk factor for heart disease; however, others are not convinced. For more on triglycerides, see Cholesterol and Triglycerides.
High blood pressure (hypertension): Blood pressure is the measurement of the force the heart exerts when pumping blood against the artery walls. In children, the appropriate amount of force depends on the child’s age and relative height. Blood pressure that stays above this amount over time is referred to as ‘hypertension.’
Hypertension can be acutely dangerous during childhood when well above normal by causing stroke or kidney damage; and even slight elevations make the heart work harder over the long term, if untreated. It's a leading risk factor for atherosclerosis, and medical research shows that without intervention, high blood pressure in children is likely to continue into adulthood, accumulating a lifetime of hard work. For more information, see High Blood Pressure.
insulin resistance (pre-diabetes): When a person eats a diet containing a lot of sugar or starch, this elevates the amount of sugar in the bloodstream, forcing the body to work harder to use and store it. This means producing more insulin, the hormone that puts sugar from the blood into tissue like brain and muscle.
Increased production of this hormone over long periods of time can lead to difficulty maintaining adequate levels, and eventually the body cannot meet its insulin needs. This leads to too much sugar in the blood that can damage the arteries, kidneys and nerves, eventually becoming diabetes. If blood work determines your child is pre-diabetic, there's a higher chance your child will develop diabetes in adulthood, or sooner.
- overweight and obesity: Excess weight is a risk factor for heart disease, independent of the adverse effects it has on cholesterol and blood pressure. Being overweight is related to a diet high in calories and not enough exercise. We used to think carrying extra weight in the form of fat was more of a physical burden; now we understand that the fat itself releases substances that are harmful to our bodies. The weight carried around the middle seems to be more harmful in this way.
metabolic syndrome: When a child has three or more risk factors (including high blood pressure, high triglycerides, low HDL, pre-diabetes and central obesity), the child has “metabolic syndrome,” a condition that's been tied to high risk for heart disease, stroke and diabetes in adults.
Few long-term studies have been done on children with metabolic syndrome, but some research shows that, like adults, children who have it may be at a higher risk for heart problems in adulthood. A Children’s Hospital Boston study of metabolic syndrome found that two-thirds of nearly 2,000 adolescents had at least one risk factor for heart disease, and almost 10 percent qualified as having metabolic syndrome. For more information on this study, see Research.
- smoking: Besides the various and frequently discussed risks of smoking, both first-hand and second-hand smoke increase the risk of atherosclerosis. Smoking causes constriction of the blood vessels that contributes to hypertension, and second-hand smoke significantly reduces HDL, the good cholesterol. Any amount of smoke exposure has negative health effects.
- family history: Having family members with heart disease or stroke early in life increases the chances of having these problems yourself, sometimes related to having other risk factors (for example genetic high cholesterol).
Risk factors such as those mentioned above occur for any of the following reasons, alone or in combination:
- genetics: Often people inherit problems related to high cholesterol or blood pressure. If a parent or siblings have these problems, genes may be to blame.
being overweight: Weight issues typically result from a combination of factors, including genetics, metabolism, environment and lifestyle. The latter two are primary influences behind the obesity epidemic in the United States. Medical professionals determine whether a child is overweight by calculating the child's body mass index (BMI). BMI evaluates an individual’s weight status in relation to height in terms of a single number. For children, normal ranges also account for ages and genders.
According to the United States Institute of Medicine’s new recommended terminology, BMI greater than the 85th percentile for age and gender indicates an overweight child, and a BMI greater than the 95th percentile indicates obesity. The Centers for Disease Control and Prevention make available a BMI Calculator online that can help you calculate your child’s BMI (see Helpful Websites).
- poor diet and lack of exercise: Sedentary pastimes like television, computers and video games have led to a general lack of fitness in youth today. If your child is inactive and eats too many processed foods, junk foods or fast foods, he or she may have increased cholesterol levels or high blood pressure.
- other medical diagnoses: An underlying metabolic or endocrine disorder can influence cholesterol and blood pressure, as well as some conditions involving organs like the liver or kidneys. Additionally, some medications can also increase cholesterol.
You may learn that your child has one or more of the risk factors above after a routine examination—which is one of the reasons why regular visits to your child’s doctor are important. Your child’s blood pressure should be measured routinely, ideally at every medical encounter, but cholesterol may not be. If your child is overweight, if you have a family history of high cholesterol or early heart disease, or if your child has other cardiovascular risk factors or certain high-risk medical conditions, we recommend you ask your doctor to perform a cholesterol test.
The National Cholesterol Education Program and the American Academy of Pediatrics recommend cholesterol screening for children ages 2 and older with any of the following risk factors:
- family history of heart disease under the age of 55, including parents and grandparents
a diagnosis in the child of any of the following:
- sedentary lifestyle and/or poor diet
- history of Kawasaki disease
- history of kidney disease, metabolic disorders or obstructive liver disease
The American Academy of Pediatrics recommends cholesterol should be checked every 3 to 5 years. You and your child’s doctor will assess the results and decide whether a referral to our clinic will be helpful.