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Sex differences in cholesterol levels among prepubertal children
Jan Kafol1, Mia Becker2, Barbara Cugalj Kern3
1Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Department of Vascular Diseases, Division of Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Atherosclerosis
|August 21, 2025
Summary
Prepubertal girls show slightly higher total cholesterol (TC) and LDL-C than boys. This sex difference in cholesterol is not seen in children with familial hypercholesterolemia (FH).
Area of Science:
- Pediatric lipid metabolism
- Cardiovascular risk factors in children
- Sex differences in health
Background:
- Sex differences in cholesterol levels are established in adults and adolescents.
- Limited data exist on cholesterol levels in prepubertal children.
- Familial hypercholesterolemia (FH) is a genetic condition affecting cholesterol levels.
Purpose of the Study:
- To investigate innate sex differences in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) in prepubertal children.
- To compare these differences in the general population versus children with FH.
- To inform early cardiovascular risk assessment strategies.
Main Methods:
- Cross-sectional study utilizing data from Slovenia's Universal FH Screening Program.
- Analysis of two population-based random samples of 5-year-old children (2014 and 2023).
- Inclusion of a referred cohort (<10 years) from the Slovenian Hypercholesterolemia Registry with genetic testing.
Main Results:
- Prepubertal girls exhibited significantly higher TC than boys in both population samples.
- In FH-negative children from the Registry, girls had higher TC and LDL-C than boys.
- No significant sex differences in TC or LDL-C were observed in FH-positive children.
Conclusions:
- Prepubertal girls have modestly higher TC and LDL-C levels compared to boys.
- The presence of a pathogenic FH variant appears to negate these innate sex differences.
- Sex-specific reference values for cholesterol may enhance early cardiovascular risk assessment in FH-negative children.
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