What are the ACC/AHA guidelines on pediatric lipid testing?

Updated: Jun 27, 2019
  • Author: Henry J Rohrs, III, MD; Chief Editor: Stuart Berger, MD  more...
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Answer

2018 American College of Cardiology (ACC)/American Heart Association (AHA), and multisocieties  [13]

  • In children and adolescents with a family history of either early cardiovascular disease (CVD) or significant hypercholesterolemia, it is reasonable to measure a fasting or nonfasting lipoprotein profile as early as age 2 years to detect familial hypercholesterolemia (FH) or rare forms of hypercholesterolemia.
  • In children and adolescents found to have moderate or severe hypercholesterolemia, it is reasonable to carry out reverse-cascade screening of family members, which includes cholesterol testing for first-, second-, and when possible, third-degree biological relatives, for detection of familial forms of hypercholesterolemia.
  • In children and adolescents with obesity or other metabolic risk factors, it is reasonable to measure a fasting lipid profile to detect lipid disorders as components of the metabolic syndrome.
  • In children and adolescents without cardiovascular risk factors or family history of early CVD, it may be reasonable to measure a fasting lipid profile or nonfasting non-HDL-C once between the ages of 9 and 11 years, and again between the ages of 17 and 21 years, to detect moderate to severe lipid abnormalities.

Normal and abnormal childhood lipid values are outlined below. [13]

TC

  • Acceptable: < 170 mg/dL (< 4.3 mmol/L)
  • Borderline: 170-199 mg/dL (4.3-5.1 mmol/L)
  • Abnormal: ≥200 mg/dL (≥5.1 mmol/L)

LDL-C

  • Acceptable: < 110 mg/dL (< 2.8 mmol/L)
  • Borderline: 110-129 mg/dL (2.8-3.3 mmol/L)
  • Abnormal: ≥130 mg/dL (≥3.4 mmol/L)

HDL-C

  • Acceptable: >45 mg/dL (>1.2 mmol/L)
  • Borderline: 40-45 mg/dL (1.0-1.2 mmol/L)
  • Abnormal: < 40 mg/dL (< 1.0 mmol/L)

TGs

  • Acceptable: (0-9 y) < 75 mg/dL (< 0.8 mmol/L); (10-19 y) < 90 mg/dL (< 1.0 mmol/L)
  • Borderline: (0-9 y) 75-99 mg/dL (0.8-1.1 mmol/L); (10-19 y) 90-129 mg/dL (1.0-1.5 mmol/L)
  • Abnormal: (0-9 y) ≥100 mg/dL (≥1.1 mmol/L); (10-19 y) ≥130 mg/dL (≥1.4 mmol/L)

Non-HDL-C

  • Acceptable: < 120 mg/dL (< 3.1 mmol/L)
  • Borderline: 120-144 mg/dL (3.1-3.7 mmol/L
  • Abnormal: ≥145 mg/dL (≥3.7 mmol/L)

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