qualify for intensification of treatment at a lower LDL-C level Cholesterolbinding resins may also be used although adherence is poor due to lack of palatability (grainy powders) or large pills requiring multiple doses in a day.162 A modified version of the proposed treatment algorithm for the treatment of elevated LDL-C, adapted from the Expert Panel Guidelines, is shown in Fig 25.6 Of note, to confirm elevated fasting lipid levels, two measurements should be taken more than 2 weeks apart but no more than 3 months apart Statin therapy should not be initiated until a 6-month trial of lifestyle management has been undertaken, as summarized above Initiation thresholds vary based on the presence of moderate- and high-level risk factors (Box 25.1) While children younger than 10 years old should not typically be treated, consideration may be made if they have a severe primary hyperlipidemia (e.g., homozygous FH with LDL-C ≥400 mg/dL), a very high-risk family history, high-risk conditions, or multiple risk factors.23 Children with LDL-C levels of 250 mg/dL or higher or TG of 500 mg/dL or higher should be referred directly to a lipid specialist Statin therapy should be given once daily, at the lowest available dose Currently, choice of statins is a matter of preference A typical initial regimen may include 5 to 10 mg of atorvastatin once daily unless the family/patient prefers a different medication (e.g., if one/both of the parents are taking a different statin) FIG 25.6 Low-density lipoprotein cholesterol (LDL-C) treatment algorithm aUse of drug therapy is typically limited to children >10 years with defined risk profiles bLifestyle modifications include maintaining 25% to 30% of daily calories from fat with