If you have a family history of heart disease, ask your health care provider to screen your children at age two. If you do not have a family history of heart disease, have your children’s cholesterol tested between the ages of nine and 11.Mary McGowan, MD
Lisa Khalafi of Bedford, NH, was 16-years-old when her mother, Jane, had a heart attack and bypass surgery at age 39. Jane’s mother died of a heart attack at age 43 and her maternal grandmother died at 39, yet it never occurred to Jane that she might be at risk. She wasn’t overweight, she didn’t smoke, her blood pressure was normal and she didn’t have diabetes. What Jane did not know was that her cholesterol put her at risk.
Jane’s LDL-Cholesterol (LDL-C) was over 350 milligrams per deciliter (mg/dL) at the time of her heart attack (LDL stands for low-density lipoproteins and is sometimes called the “bad” cholesterol). Normal LDL-C is less than 100 mg/dL and it should be less than 70 mg/dL in people with heart disease. Even though she was treated with cholesterol-lowering medications, it wasn’t until I met Jane five years later that she learned her diagnosis—familial hypercholesterolemia—a common genetic disorder. Now 47, Lisa knows she inherited the familial hypercholesterolemia gene and so have three of her four children.
Familial hypercholesterolemia affects one in every 250 people worldwide, and should be suspected in adults with an untreated LDL-C greater than 190 mg/dL, and in children with an LDL-C over 160 mg/dL. Some populations, including French Canadians, are at higher risk. Each time a person with familial hypercholesterolemia has a child, there is a 50 percent chance of passing the gene on, and diet is not sufficient to normalize cholesterol levels—everyone with familial hypercholesterolemia requires medications.
Lisa, has been on cholesterol-lowering medications since her 20s and has never had a cardiac event. Her children have been treated since they were ten-years-old. The American Academy of Pediatrics and the American Heart Association recommend that children from families with premature heart disease have a cholesterol profile at age two, and that all children be screened between the ages of nine and 11 and again between ages 17 and 21.
Children suspected of having familial hypercholesterolemia should be treated with both a low-fat diet and cholesterol lowering medications beginning at age ten. Studies have shown that by this age, children with familial hypercholesterolemia begin depositing cholesterol in their hearts and other arteries. Individuals treated as children had far fewer heart attacks and deaths from heart disease as adults, compared to their parents who were not treated until later in life.
What can you do? If you have a family history of heart disease, ask your health care provider to screen your children at age two. If you do not have a family history of heart disease, have your children’s cholesterol tested between the ages of nine and 11.
Mary McGowan, MD, is the co-director of the Lipid Clinic at Dartmouth-Hitchcock Heart & Vascular Center, and is an assistant professor of Medicine at The Geisel School of Medicine.