This information can inform a focused risk discussion designed to improve high-risk lifestyle behaviors in- cluding tobacco use, sedentary lifestyle and/or poor When young adults with hyper- cholesterolemia or multiple risk factors are identified, lifestyle intervention is indicated. To date, no long- term RCTs with cholesterol-lowering drugs have been carried out in those 20 to 39 years age. However, a primary prevention RCT in those younger individuals at low to moderate short-term risk, but at high lifetime risk has been proposed.S4.4.4.2-13 One approach to identifying young adults who could benefit from statins or drug combination would be to detect significant coronary atherosclerosis with coronary artery calcium (CAC) scores. Its use for this purpose has been suggested.S4.4.4.2-14 But again, ab- sence of RCT data precludes guideline recommenda- tions at this time. CLINICAL STATEMENTS AND GUIDELINES 4.4.4.3. Children and Adolescents Recommendations for Children and Adolescents Referenced studies that support recommendations are summarized in Online Data Supplements 18 to 21. COR LOE Recommendations I A In children and adolescents with lipid disorders related to obesity, it is recommended to intensify lifestyle therapy, including moderate caloric restriction and regular aerobic physical activity.S4.4.4.3-1 S4.4.4.3-4 I B-NR In children and adolescents with lipid abnormalities, lifestyle counseling is beneficial for lowering IIa B-R In children and adolescents 10 years of age or older with an LDL-C level persistently 190 mg/dL or higher ( 4.9 mmol/L) or 160 mg/dL or higher (4.1 mmol/L) with a clinical presentation consistent with FH (see Section 4.2.) 