By Daniel Rothberg

igh cholesterol runs in Beanie Feldstein’s ’11 family. When Feldstein was 5 years old, her pediatrician ordered a blood test and discovered that she had high cholesterol. Since then, in an effort to lower her cholesterol, Feldstein has eliminated sugar and dairy from her diet and exercises frequently.

Hypercholesterolemia (elevated cholesterol) in adolescents is uncommon. In fact, only 10 percent of children and adolescents have high cholesteral, cardiologist Michele Hamilton (Matthew Goldhaber ’11) said. But adolescents like Feldstein who have a family history of high cholesterol, heart attack or stroke are likely to have high cholesterol. In addition, a sedentary lifestyle and a diet that includes both large amounts of fats and carbohydrates can contribute to the development of elevated cholesterol, cardiologist Norman Lepor (Marissa ’12) said.

Found in the bloodstream, cholesterol is an important molecule for the body. However, the accumulation of too much cholesterol in the bloodstream can result in atherosclerosis (plaque buildup in the arteries), which, in turn, can lead to a heart attack or stroke.

Since cholesterol cannot dissolve in the blood, it must be transported throughout the body in what are called “lipoproteins.” In the body, there exists both low-density lipoprotein (LDL) and high-density lipoprotein (HDL). An increased amount of LDL cholesterol, known as “bad” cholesterol, increases the risk of heart attack or stroke. However, an increased amount of HDL cholesterol, known as “good” cholesterol, seems to protect against heart attacks, according to the American Heart Association.

Over time, elevated levels of cholesterol are dangerous because they can exacerbate the progression of atherosclerosis.

Two ways to lower cholesterol include “being aggressive with nutrition” and “regular exercise,” Lepor said.

He said that teenagers should exercise for about 30 to 60 minutes per day. Exercise benefits the cardiovascular system by reducing LDL cholesterol and raising HDL cholesterol. This process slows down the progression of plaque buildup in the arteries, Lepor said. Apart from lowering cholesterol, exercise helps prevent the development of obesity and diabetes, he said.

For adolescents struggling to lower their cholesterol, the American Academy of Pediatrics suggests that teenagers maintain a healthy diet.

“The way we always start with adolescents is with their diet,” Hamilton said.

One way that teenagers can improve their diet is by avoiding processed foods, she said.

According to the American Heart Association, an acceptable concentration of LDL cholesterol in children and adolescences is less than 110 mg/dL. A concentration of LDL cholesterol between 110–129 mg/dL is considered by the organization to be the borderline between low and high LDL cholesterol. Any concentration of LDL cholesterol greater than 130 ml/dL is defined as high.

The American Academy of Pediatrics suggests that cholester-lowering medications should only be considered for children older than 8 years old with an LDL concentration greater than 190 mg/dL. However, they suggest that medication be considered for children with an LDL concentration greater then 160 mg/dL if that child has a family history of early heart disease or two additional risk factors for high cholesterol. Additionally, for children with diabetes, they suggest that medication be considered if the child’s cholesterol is greater than 130 mg/dL.

While doctors first recommend lifestyle changes, such as exercise and diet, to combat high cholesterol, Hamilton has found that teenagers often find it difficult to make lifestyle changes because the payoff from those changes will not come right away.

“It is really difficult to convince adolescents to make a change… for something that may happen 20 years down the line,” Hamilton said.

At the recommendation of her pediatrician, Rachel Katz ’11 was tested for high cholesterol when she was 14. Katz was surprised to learn that she had high cholesterol since she is a vegetarian and exercises regularly, she said.

Katz said she is not too concerned with lowering her cholesterol levels.

“I probably should do something about it but I don’t really care. I’m not the best about it,” Katz said. “I like my dairy products.”

The American Heart Association explains that atherosclerosis is a condition where lipids accumulate as plaque in the inner lining of a large to medium-sized artery. A thick and hard substance, plaque can cause the arteries to be less flexible. When too much LDL cholesterol or too many triglycerides, a type of fat, flows through the bloodstream, plaque in the arteries can build up. The presence of plaque can partially or completely impede the flow of blood through the artery.

“If you can lower the cholesterol with diet and exercise you can keep it [plaque buildup] from progressing and sometimes get it to regress,” Hamilton said.

In addition to elevated levels of cholesterol, risk factors for developing atherosclerosis include high blood pressure, high levels of triglyceride and smoking cigarettes.

For children with a family history of high cholesterol, high fat levels or early cardiovascular disease, the American Academy of Pediatrics recommends starting to screen for high cholesterol at the age of two years old. From that point, they suggest that children with a family history be screened for high cholesterol every three to five years. The organization also recommends screening for children who are overweight, have high blood pressure or diabetes, or whose family medical history is unknown.

The American Academy of Pediatrics recommends that children who are screened for elevated cholesterol be tested using a fasting lipid profile, which is a blood test that requires patients to fast for 12 hours beforehand.