Sisters Elizabeth, left, and Nicole Martin share a family trait: high cholesterol.

MCT / Paul Tople

Nicole Martin did everything right when it came to controlling her cholesterol.

She avoided red meat and food loaded with saturated fat and instead opted for lots of heart-healthy oatmeal and whole grains.

She ran and exercised while maintaining a proper weight.

But by the time she reached her mid-teens, her parents and doctor realized all those good habits simply were no match for her bad genes.

Her father and paternal grandmother both had a history of high cholesterol that didn’t respond to diet changes and exercise.

Despite all her own efforts, Martin’s total cholesterol at age 15 still hovered around 300, compared with the recommended level of less than 200.

Martin, now 20, has been taking cholesterol-lowering statin medication for the past five years.

And soon her 13-year-old sister, Elizabeth, could be joining her.

How young is too young when it comes to starting medicine to battle high cholesterol?

For children considered at risk for cardiovascular problems, the target age for at least considering medication is getting younger.

The American Academy of Pediatricians recently issued a highly publicized set of guidelines for testing and treating cholesterol levels in children.

The group is recommending — for the first time — that doctors consider giving cholesterol-lowering drugs to some children as young as 8 to ward off future heart problems.

That doesn’t mean that every child with high cholesterol should be medicated, said Dr. Jatinder Bhatia, chief of neonatology at the Medical College of Georgia in Augusta and a member of the academy’s committee that drafted the recommendations.

Nor is the group advocating that all children have their cholesterol tested, Bhatia said, though he added that it’s probably a good idea.

Rather, he said, the guidelines provide a more targeted approach for testing children considered at high risk and then treating those for whom diet changes and exercise aren’t enough.

Children with risk factors for cardiovascular problems already have been getting their cholesterol tested, said John Lane, director of pediatric cardiology at Akron Children’s Hospital in Ohio.

“What the new guidelines do is move it down in age a bit,” Lane said. “There was a lot of variation in what was done.

“The rationale is that we’re seeing the incidence of obesity explode in the United States in children and adolescents. We’re seeing more hypertension and diabetes and basically all the risk factors for the development of coronary artery disease. What the guidelines do that’s helpful is focus more attention on the people at risk and trying to intervene.”

The American Academy of Pediatrics recommends improved diet with nutritional counseling and increased activity as the first course of action for overweight children with high triglyceride levels or low HDL, or “good” cholesterol.

For patients 8 and older with high levels of LDL, or “bad” cholesterol, and a family history or other risk factors, medication “should be considered,” the guidelines state.

In the case of the Martin sisters of Akron, Ohio, their mother, Judy, has hesitated to start them on statin medications too young.

Because of her family history of cholesterol, Elizabeth Martin was tested by age 10 and found to share the family risk.

The thin, active girl’s cholesterol level also has been near 300, the same as her older sister’s before beginning medication to bring it down to normal levels.

Three years ago, Elizabeth’s mother and their doctor agreed to be wary, as there weren’t many studies “to show if you start the drugs at a young age, they don’t do anything,” the mother said. But as her youngest daughter gets older, she’s more willing to consider cholesterol-lowering drugs: “The older she gets, the more open I’ll be.”SCREENING KIDS

The new guidelines recommend fasting cholesterol screening after age 2 but no later than age 10 in these cases:

• Children with a family history of high cholesterol or heart disease.

• Youngsters whose family history is unknown.

• Those with other factors for heart disease, including obesity, high blood pressure, diabetes or smoking.