Cholesterol is a type of fat in the blood. It is used by the body to make hormones, bile acid and other needed substances. The body produces some cholesterol. But most of the cholesterol circulating in the blood comes from the foods we eat.

Cholesterol is carried in the blood in the form of lipoproteins. There are two main kinds. Low-density lipoproteins (LDL cholesterol), the most common form, carry cholesterol to the tissues. High-density lipoproteins (HDL) pick up excess LDLs and carry them to the liver, where they are removed from the body.

If LDL levels are too high, the excess lines the walls of the arteries and can combine with other materials to form plaque. The plaque can lead to an arterial blockage in one of three ways. First, pieces of plaque can break lose and travel through the bloodstream, becoming trapped in a narrower artery. Second, the body may sense the broken plaque as an injury and try to "repair" the damage, leading to a build-up of scar tissue. Third, like a clogged drain pipe, the plaque can build up enough to close off the artery. In any of the cases, a blocked artery means part of the body doesn't get enough oxygenated blood. If the condition isn't fixed (i.e., treated) tissues will die. A blockage in the heart can lead to a heart attack. In the brain, it can cause a stroke.

Family and Cholesterol Awareness

The American Heart Association estimates 106.7 million American adults have high cholesterol. Family history of elevated cholesterol increases the risk for siblings and children. In some cases, however, there is a definite genetic link associated with elevated cholesterol. Researchers say this condition, called familial hypercholesterolemia, affects about two out of every 1,000 people. Patients tend to have very high cholesterol levels and are at increased risk for early death from heart disease. In fact, young adults (20 to 39) with familial hypercholesterolemia are 100 times more likely to die from coronary artery disease.

Even for children without familial hypercholesterolemia, high cholesterol can have serious consequences for their adult health. Many children with elevated cholesterol levels will continue to have the problem as adults. And earlier development of the problem may mean they will be at risk for artery-clogging plaque and heart attacks at a much younger age.

Health experts don't recommend mass screening for cholesterol in children. Children under two need cholesterol for their growing bodies. After age two, screening may be warranted if a child has a family history of high cholesterol (over 240 mg/dL) or early heart disease, heart attack or stroke.

Julie Brothers, M.D., a Pediatric Cardiologist with The Children's Hospital of Philadelphia, says in addition to family history, some cases of elevated cholesterol are caused by lifestyle factors, namely diet and obesity. Thus, cholesterol screening may also be recommended for children who are overweight or who have diabetes or high blood pressure. Cholesterol screening may also be beneficial for teens who smoke and those taking oral contraceptives or retinols for acne (these medications can sometimes raise cholesterol levels).

Children can be placed on a cholesterol-lowering diet after age two. Brothers says it's usually easier to start these changes at a young age, before children develop a taste for fast food. Parents can keep supplies of ready to eat healthy snacks, like apple slices and cut veggies, instead of providing chips, pastries and other unhealthy foods. It's also easier if the entire family gets involved in making the dietary changes a permanent part of a healthy lifestyle.

Brothers says, in extreme cases, there are medications to help lower cholesterol in children. A statin drug may be given to boys as young as ten and girls after they begin menstruation.

For information on cholesterol, screening or treatment:

American Heart Association

National Heart, Lung and Blood Institute