Cholesterol and People with Down’s Syndrome
While the acute health problems associated with Down’s Syndrome can get downright overwhelming, we as responsible caregivers can’t ignore the chronic, long term health issues either.
The basic fact that children with Down’s Syndrome tend to have higher cholesterol than their peers tends to get lost in the roar of learning disabilities, hearing problems, and immune deficiencies.
However, high cholesterol and it’s attendant problems are one of the deadliest health conditions in the modern world.
We can’t afford to ignore cholesterol issues if our children with Down’s Syndrome are to live up to their full potential.
Recent findings on Down Syndrome and Cholesterol
According to a report given by Dr. Tahira G. Adelekan at the 2006 annual meeting of the Society for Developmental and Behavioural Pediatrics, children with Down’s Syndrome appear to have higher atherosclerosis-producing cholesterol levels than children without the disorder.
In her study she found that children with Down’s Syndrome showed an average increase of 12.9 mg/dL in total cholesterol levels.
She also found that, on average, the children she studied showed an increase of 12.5 mg/dL in low-density lipoprotein cholesterol levels along with a 30.6 mg/dL average increase in triglycerides and a 6.9 mg/dL average decrease in high-density lipoprotein cholesterol levels.
What These Cholesterol Numbers Mean for Your Child with Down Syndrome
We’re just starting to find out how tricky a subject cholesterol really is.
From one perspective, cholesterol is cholesterol. It’s a kind of fat, and the body needs it in order to create many different kinds of cells.
Cholesterol is not soluble in blood, so the body has a couple of different ways to get it from one point to another. The main way the body does this is to use “baskets” made of protein chains, which is where low-density and high-density lipoprotein comes into the equation.
If cholesterol were just free-floating in the blood, it would congeal into fat globules, block a blood vessel, and anyone would die fairly quickly. Instead, the body manufactures and uses these protein chains to keep that from happening.
Low-density lipoprotein carriers (LDL-C) are what the body uses to bring cholesterol to areas where it’s needed to create cells.
High-density lipoprotein carriers are what the body uses to break down and eliminate cholesterol from the body.
LDL-C is “bad” for a couple of reasons.
First, cholesterol carried by low-density lipoprotein chains (LDL cholesterol) is not yet on its way out of the body.
Second, if the cholesterol carried by low-density protein chains can’t be used by the body, the cholesterol is deposited on the wall of the artery instead, which is how arteries harden.
In contrast, cholesterol contained in high-density lipoprotein chains (HDL cholesterol) is on its way to be metabolized, and high-density chains will often pick up cholesterol deposited on the artery walls in order to clear it out.
Triglycerides indicate free-floating fat of some kind in the blood. It’s not a direct indication of cholesterol, but high triglycerides do tend to be associated with high cholesterol levels.
Cholesterol comes from three main sources.
One is, of course, dietary. The two others are the liver and the gall bladder, both of which are capable of creating cholesterol from other sources.
These three main sources are what all high-cholesterol treatment management plans are based on.
If the diet just has way too much cholesterol in it, bringing those high levels down is fairly easy with a diet change and sufficient exercise.
If, on the other hand, the liver or gall bladder synthesizes too much cholesterol, life gets a little more difficult. Genetics, not lifestyle, determines how much cholesterol the liver and gall bladder will produce.
If the genes say to produce way too much cholesterol, the person will probably have to take cholesterol-lowering medication in addition to diet and exercise.
The problem of high cholesterol in children
The problem with children having elevated levels of low-density lipoprotein cholesterol is that children do need cholesterol as building blocks more than adults do.
However, in children with cholesterol problems, they don’t need it to the level they have it.
Many of the cholesterol drugs on the market today are aimed at adults, and modifying them for children requires a great deal of care.
Lack of care and pedatric understanding can lead to cholesterol levels so low that the child can’t grow properly.
What This Means For Your Child with Down’s Syndrome
These findings indicate that children with Down’s Syndrome require much more active vigilance in regards to prevention of cardiovascular disease.
Accurate assessments of their current cholesterol states and of their risk of developing problems needs to be ongoing throughout their medical care.
If elevated cholesterol levels are not managed properly from a relatively young age, a child could be at serious risk of stroke, heart attack, angina, or any of the other myriad problems that long-term high cholesterol can cause.
How To Control High Cholesterol in Children with Down’s Syndrome
Diet and exercise
The first step to controlling high cholesterol in a child with Down’s Syndrome, or any child for that matter, is, of course, to control his or her diet and exercise.
While this can be difficult, especially with a child who has favorite fatty foods, it is necessary.
A competent pediatrician who is well versed in the health problems caused by Down’s Syndrome is a necessary partner.
That pediatrician should take a baseline of the child’s cholesterol levels, make recommendations from there, and perform the cholesterol tests as often as indicated.
Another good partner is a good dietician or nutrition expert.
He or she can help you design a diet and meal plan that will both limit cholesterol and appeal to your child.
If the child particularly loves a high-cholesterol treat, portion control might be the way to go. Offer a smaller portion of the treat in return for good eating or cooperation during exercise.
Another member of your medical team should be a competent physical therapist. Children with Down’s Syndrome often find normal exercise to be too painful or even frankly impossible. A good physical therapist can help craft exercises that will get your child’s heart rate up into the aerobic range without making the child miserable.
Cholesterol Lowering Medication
If diet and exercise changes alone can’t bring your child’s cholesterol levels down to the safety zone, cholesterol-lowering medication may be indicated.
There are a few lipid-lowering medications out there that have tested relatively safe on children, but not many.
The pickings are particularly slim for children under eight years of age.
In addition, many cholesterol-lowering medications have dangerous side effects and multiple problems interacting with other medications.
Some can cause liver, kidney or muscle damage, while others can cause problems within the gastrointestinal tract.
Because of these problems, medication therapy is usually only suggested for children who really need it. Unfortunately, children with Down’s Syndrome often fall into this category.
Working out whether to use cholesterol medications
The best suggestion is to try diet and exercise alone for about six months.
If cholesterol levels haven’t come down to reasonably safe within that time period, it may be time to look at medication.
You’ll need to talk to your pediatrician or specialist to learn about all the medications available and pick the one that suits your child best.
Each cholesterol-lowering medication that’s suitable for children has its own problems, its own set of concurrent medications it doesn’t work well with, and its own risks.
Only you can decide which cholesterol-lowering medication your child should take because only you know your child’s reactions, current medications and circumstances.
Be prepared to have a lengthy discussion with your pediatrician in order to learn as much as possible about the medications available today.
High Cholesterol and Down’s Syndrome: How Do They Relate?
While researchers don’t understand everything about how Down’s Syndrome works, they have recently identified a gene that normally controls cholesterol levels within cells that is directly affected by trisomy 21.
The research in question was aimed at Alzheimer’s disease, as many people with Down’s Syndrome get Alzheimer’s early in life.
While the scientists were trying to find the gene that contributes to Alzheimer’s, they found a gene that regulates cell levels of cholesterol.
Current findings seem to indicate that the two are connected, but researchers aren’t yet sure exactly how.
When they figure it out, we’ll have made enormous steps in combating cholesterol and early Alzheimer’s in people with Down’s Syndrome.
In addition, we’ll have a much better understanding of Alzheimer’s disease in people without Down’s Syndrome, so the possibilities for the near future are exciting indeed.
Down’s Syndrome and Cholesterol in Conclusion
Cholesterol was not a big problem for people with Down’s Syndrome in the past for the tragic reason that they often didn’t get to live long enough to worry about it.
Modern research, improved medical techniques, and increased socialization and stimuli have all greatly contributed to pushing the life expectancy of people with Down’s Syndrome closer to where it belongs, the same life expectancy as everybody else.
With that longer lifespan comes a myriad of opportunities for people with Down’s Syndrome, including the opportunity to suffer from the same chronic, long-term health effects of high cholesterol.
However, unlike many others, people with Down’s Syndrome don’t get their high cholesterol levels just from eating fatty foods or smoking.
Normally some people in the general population will be genetically predisposed to elevated high cholesterol during adulthood, but their cholesterol levels are fine during the high-energy, fast tissue building stage of childhood.
In contrast, problems with high cholesterol start early for kids with Down’s Syndrome.
The only possible remedy at this point is to find out as much as you can and help develop a treatment regimen that will work for your child.
By doing so you contribute to both the length and the quality of their life.
Research and Main write by Loni Ice, minor editing by Donald Urquhart