Heart Health Starts Now: What You Need to Know About Teen Cholesterol

Think cholesterol is just an adult concern? It’s time for both parents and teens to understand that heart health begins in the teenage years. The choices made today could literally save lives later.

What Is Cholesterol?

Yale Medicine explains that cholesterol is a waxy, fat-like substance that’s actually essential for important body functions, like making hormones, cell membranes, and certain vitamins. But there are different types, and some can be harmful when levels get too high.

Think of cholesterol like traffic in the bloodstream:

• LDL Cholesterol (“Bad” cholesterol): This forms plaque on artery walls, like gunk building up in pipes. Too much LDL creates traffic jams in arteries.
• HDL Cholesterol (“Good” cholesterol): This helps flush out plaque from arteries, acting like a cleanup crew that keeps traffic moving smoothly.
• Triglycerides: These aren’t cholesterol but a type of fat your body stores for energy. When you eat more calories than you need (especially from carbohydrates and sugars), your body converts the excess into triglycerides and stores them in fat cells. High levels increase the risk of heart attack, stroke, and pancreatitis.

Reality Check: Teens DO Get High Cholesterol

Many parents assume cholesterol testing is only for adults, but that’s not the case. Here are some important stats from the American Heart Association and HealthMatch.io.

• About 1 in 5 teens has cholesterol levels that are out of the healthy range
• Almost 9% of 16-19-year-olds have high total cholesterol
• As many as 1 in 250 people have familial hypercholesterolemia, but the condition gets diagnosed in fewer than 10% of those who have it
• High cholesterol shows up more in teen girls, teens with obesity, non-Hispanic Black and Asian teens, and older teens aged 16 to 18

Common Myths About Cholesterol

Myth: “My teen would be able to feel it if they had high cholesterol.”
Reality: There are usually no warning signs for high cholesterol. Your teen might not know they have unhealthy levels until something serious happens, like a heart attack or stroke (CDC). This is exactly why family screening matters.

Myth: “All cholesterol is bad.”
Reality: Your body needs cholesterol to make hormones and build cells. HDL cholesterol is the “good” type that helps remove excess cholesterol from your arteries. Problems start when there’s too much LDL (“bad”) cholesterol building up in arteries (CDC).

Myth: “Our family can’t do anything to change cholesterol levels.”
Reality: Making healthy food choices as a household, staying active together, avoiding smoking, and working with health care providers can all make a real difference (CDC).

Myth: “Diet and exercise alone can always control cholesterol.”
Reality: While many families can achieve good cholesterol levels through healthy eating and exercise, some people also need medicines, especially those with familial cholesterol, which refers to Familial Hypercholesterolemia (FH), a genetic condition that causes dangerously high levels of LDL (“bad”) cholesterol from a young age (CDC).

When Should Your Teen Get Tested?

All children should have their cholesterol checked between the ages of 9 and 11 and again between the ages of 17 and 21, according to the American Academy of Pediatrics and American Heart Association. Currently, only 11% of people ages 9 to 21 actually get screened, compared to more than 70% of adults.

Additionally, teens should be tested if they have:

• A family history of high cholesterol (240 mg/dL or higher)
• Family history of heart attacks or strokes before age 55 (men) or 65 (women)
• High blood pressure, diabetes, or obesity
• Unknown family health history

If there’s a family history of a high risk for heart attacks or strokes, cholesterol testing might start as early as age 2. Make sure to get your teen’s annual wellness exam so that your family and your teen’s pediatrician can make sure that cholesterol is checked appropriately.

Dr. Brittany Hodgson, a pediatrician at Legacy Community Health, emphasizes the importance of regular wellness visits: “Very few families decline cholesterol testing when we offer it at the 11-year-old wellness visit. The biggest barrier is when teens miss their annual wellness checks altogether. If families miss appointments, then the teen isn’t screened.”

What Are Healthy Numbers for Teens?

For teens (ages 19 and younger), healthy levels are:

• Total cholesterol: under 170 mg/dL
• Non-HDL cholesterol: under 120 mg/dL
• LDL cholesterol: under 100 mg/dL
• HDL cholesterol: 45 mg/dL or higher

Don’t stress about memorizing these numbers, but do understand that getting tested helps teens know where they stand. Your health care provider will help you understand what the specific numbers mean.

Family Action Plan: What You Can Do Together

• Make Movement a Family Priority: Federal guidelines say teens need at least an hour of moderate to vigorous physical activity every day.
• Create Heart-Healthy Family Meals: Sean Barrett, Legacy Community Health’s Director of Nutrition and Fitness, notes: “Eating healthy is hard when it is only one. Parents need to set an example for the family to follow.” A heart-healthy diet includes greens, whole grains, and fruits, plus nuts and extra virgin olive oil. Research shows cholesterol can improve in as little as three months with these changes.
• Set Family Screen Time Boundaries: Guidelines suggest keeping screen time to two hours or less per day. More movement equals better heart health for everyone.
• Address Tobacco and Alcohol as a Family: Smoking and heavy drinking can make cholesterol problems worse. Have honest conversations about these risks.

When health care providers work with families on cholesterol management, they look beyond just the numbers.

“We should always look at the patient as a whole. This includes cultural norms, economic factors – Can they afford food? Are they in a food desert? Who takes care of the family?” he said. This approach ensures that recommendations are realistic and respectful of each family’s situation.

Dr. Hodgson adds that many families find it helpful to understand the connection between cholesterol and blood sugar management: “I often discuss cholesterol alongside diabetes and sugar problems because the dietary and exercise recommendations benefit both conditions. Many families are already thinking about blood sugar, so connecting these conversations makes the guidance more relevant and easier to implement.”

When Lifestyle Changes Aren’t Enough

Sometimes, even with healthy family habits, cholesterol stays high because of genetics. According to the American Academy of Pediatrics, teens might need cholesterol medications if:

• Their LDL cholesterol stays higher than 190 mg/dL despite six months of lifestyle changes
• Their LDL cholesterol is at least 160 mg/dL and they have a family history of early heart disease
• Their LDL cholesterol is higher than 130 mg/dL and they have diabetes
• They have familial hypercholesterolemia (FH)

While most teens do not need to take medications to reduce their cholesterol levels, cholesterol-lowering medications, such as statins, are generally considered safe and effective. Statins don’t interfere with teens’ growth, puberty, or brain development.

A 2019 study in the New England Journal of Medicine showed that treating children with familial hypercholesterolemia using cholesterol-lowering statin drugs safely reduced their heart disease risk as adults. Only about 1% of children and teens actually need medication, and lifestyle changes always come first.

Ready to Take Action?

Heart disease risk factors present during the teen years, including high cholesterol, lead to serious heart problems in adulthood. Getting cholesterol checked and maintaining healthy family habits now isn’t about being overprotective or anxious. It’s about being informed and proactive. Your family’s future health depends on the choices you make together today.

Contact Legacy Community Health to schedule a cholesterol screening for your teen and discuss your family’s heart health with our health care providers.

Sources: Yale Medicine, CDC, American Heart Association, MedlinePlus, HealthMatch.io, NIH MedlinePlus Magazine