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.) and who do not respond adequately with 3 to 6 months of lifestyle therapy, it is reasonable to initiate statin IIa B-NR In children and adolescents with a family history of either early CVD* or significant hypercholesterolemia, it is reasonable to measure a fasting or nonfasting lipoprotein profile as early as age 2 years to detect FH or rare forms of IIa B-NR In children and adolescents found to have moderate or severe hypercholesterolemia, it is reasonable to carry out reverse-cascade screening of family members, which includes cholesterol testing for first-, second-, and when possible, third-degree biological relatives, for detection of familial forms of hy IIa C-LD In children and adolescents with obesity or other metabolic risk factors, it is reasonable to measure a fasting lipid profile to detect lipid disorders as components of the IIb B-NR In children and adolescents without cardiovascular risk factors or family history of early CVD, it may be reasonable to measure a fasting lipid profile or nonfasting non HDL-C once between the ages of 9 and 11 years, and again between the ages of 17 and 21 years, to detect moderate to severe lipid *Family history of early CVD is defined here as MI, documented angina, or atherosclerosis by angiography in parents, siblings, grandparents, aunts, or uncles (<55 years of age for men, <65 years of age for women). 