Preventive Cardiology

LDL cholesterol, HDL cholesterol, & triglycerides

What is cholesterol?

Cholesterol is a waxy substance that can be found in all parts of your body. Some cholesterol is important to healthy body function, since it aids in the production of cell membranes, hormones and vitamin D.

We obtain cholesterol through two processes: 1) the liver produces it; and 2) we consume it in the foods we eat. Animal products such as egg yolks, red meats, poultry, some seafood, and whole milk dairy products contain cholesterol—while plant foods such as fruits, vegetables, and whole grains do not. All cholesterol that we eat exceeds what the body needs, as your liver produces all the cholesterol it needs.

Cholesterol and other fats are transported through the blood stream in the form of round particles called lipoproteins. The two most commonly known lipoproteins are low-density lipoprotein (LDL) and high-density lipoprotein(HDL). Hypercholesterolemia—too-high levels of cholesterol in the blood—is a major risk factor for heart disease and can lead to heart attack in adulthood.

What is LDL (Low-Density Lipoprotein) Cholesterol?	What is HDL (High-Density Lipoprotein) Cholesterol?
This type of cholesterol is commonly called “bad” cholesterol. Too much contributes to the formation of plaque buildup in the arteries, known as atherosclerosis. LDL levels should be below 130 mg/dL in most people. To help lower LDL levels, help your child to: avoid foods high in saturated fat, trans-fat, dietary cholesterol, and excess calories increase exercise maintain a healthy weight	This type of cholesterol is known as “good” cholesterol, and is a type of fat in the blood that helps to remove LDL cholesterol from the blood vessels, preventing fatty buildup and the formation of plaques. HDL should be as high as possible, preferably greater than 45 mg/dL. It is often possible to raise HDL by: exercising regularly, daily if possible maintaining a healthy body weight

What is LDL (Low-Density Lipoprotein) Cholesterol?

What is HDL (High-Density Lipoprotein) Cholesterol?

This type of cholesterol is commonly called “bad” cholesterol. Too much contributes to the formation of plaque buildup in the arteries, known as atherosclerosis. LDL levels should be below 130 mg/dL in most people.

To help lower LDL levels, help your child to:

avoid foods high in saturated fat, trans-fat, dietary cholesterol, and excess calories
increase exercise
maintain a healthy weight

This type of cholesterol is known as “good” cholesterol, and is a type of fat in the blood that helps to remove LDL cholesterol from the blood vessels, preventing fatty buildup and the formation of plaques. HDL should be as high as possible, preferably greater than 45 mg/dL. It is often possible to raise HDL by:

exercising regularly, daily if possible
maintaining a healthy body weight

What are triglycerides?

Triglycerides are another class of lipids (fats) found in the bloodstream and in all the cells of the body. Triglycerides come directly from the fats and carbohydrates we eat. These calories are converted to triglycerides and stored in fat cells. The exact link between triglyceride levels and heart disease is debated and is currently under investigation. But it's clear that many children with elevated triglyceride levels also have other risk factors, such as low HDL levels, pre-diabetes or excess weight.

How are cholesterol and triglycerides measured?

Cholesterol and triglyceride levels are measured through a test of the blood. The first check of a child’s cholesterol is currently recommended for 2 years of age if the child has a family history of elevated cholesterol or cardiac disease/event before the age of 55 in men and 65 in women, or other risks for high cholesterol. This blood test is most accurate when measured in the fasting state, that is, when the blood sample is taken after at least 8 (and ideally 12) hours without food or beverage besides water. This provides a reliable picture of the fat content of your child’s blood without interference from food.

What is “normal” for cholesterol and triglycerides? Why is it important?

The following guidelines are set by the American Academy of Pediatrics and the National Cholesterol Education Program for children between the ages of 2 and 19 for fasting cholesterol panels:

	Acceptable	Borderline	Too High/Too Low
Total Cholesterol	<170 mg/dL	170-199 mg/dL	> 200 mg/dL
LDL Cholesterol	< 110 mg/dL	110-130 mg/dL	> 130 mg/dL
HDL Cholesterol	>45 mg/dL	36-44 mg/dL	< 35 mg/dL
Triglycerides	< 100 mg/dL	100-130 mg/dL	130-150 mg/dL

Too much “bad cholesterol” means a higher likelihood of plaque formation. Studies have found low HDL to be the most common risk factor for atherosclerosis. HDL levels greater than, or equal to, 40 mg/dL are protective in adults. Elevated triglycerides, in addition to placing children at risk for acute pancreatitis (a painful inflammation of the pancreas), may also be associated with heart disease. Often, they're also elevated in children with other risk factors for heart disease, such as obesity.

What causes elevated LDL and triglyceride levels, and low HDL levels?

Various elements influence one’s lipid panel. Elevated LDL and low HDL may be inherited from one or both parents, and lifestyle can also contribute. As mentioned before, your liver produces all the cholesterol necessary for the body to function; foods such as meats, fish and those high in saturated fat and calories simply add to what the liver already produces. They can also be the cause behind elevated triglycerides, particularly if someone is already overweight or obese. Other medical conditions that affect the liver or kidneys may also increase one’s cholesterol, as can current or previous exposure to certain medications. For more information, see Who We Help and Risk Factors.

How are elevated cholesterol and triglyceride levels treated?

The first line of treatment typically entails diet and lifestyle changes tailored to your child’s specific needs. Other treatments may include dietary supplements, exercise prescriptions or possibly pharmacologic intervention. For further discussion of our approach to treating cholesterol, please see The Healthy Heart Treatment Plan.