How are pediatric LDL-C levels of 130 mg/dL or higher treated?

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

A TG level of 125 mg/dL or less with an average LDL-C level of 130 mg/dL or higher defines a Frederickson type IIA phenotype. National Cholesterol Education Program (NCEP) recommendations for children directly address this phenotype. Dietary measures and exercise should be instituted, and secondary causes should be sought. Ideally, the goal should be to achieve an LDL-C level of less than 110 mg/dL.

The child should engage in regular aerobic exercise. Some patients live in areas that are considered unsafe, and parents limit their children's outdoor activity. Video games, computers, and television viewing have replaced many outdoor activities. Active video games such as Dance Dance Revolution, which uses flashing lights on a dance pad, are now gaining popularity. With advancement in video game consoles, this activity is now available at home or in video arcades. Other ways to increase physical activity include doing chores around the house, such as raking leaves, vacuuming, sweeping, and walking the dog.

Ideal weight should be maintained or achieved. Although weight loss may not be feasible in a growing child, weight maintenance is not an unreasonable goal, so that the child can eventually "grow into" his or her weight. Another approach is to set a goal of lowering the rate of weight gain, in order to bring the child to an appropriate weight at some time in the future (eg, within 1-5 years).

Secondary causes of elevated LDL-C levels should be minimized or eliminated (eg, by treating hypothyroidism or improving glycemic control in diabetes). Laboratory testing should include thyroid studies (free thyroxine [T4], thyroid-stimulating hormone [TSH]), glycated hemoglobin studies (if diabetes is present), liver function tests, and renal function testing (eg, creatinine, BUN [blood urea nitrogen], uric acid and urinalysis).

If TG and LDL-C levels are both elevated (eg, TGs ≥125 mg/dL and LDL-C ≥130 mg/dL), a type IIB phenotype is most commonly present (versus the very rare type III phenotype); the nonpharmacologic treatment of the type IIB phenotype is similar to treatment of the type IIA phenotype.


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