Screening Kids for High Cholesterol

Cholesterol tests should be given to all children as early as age 9, according to new guidelines from the National Heart, Lung and Blood Institute.

All children should receive a cholesterol test before they reach puberty, according to new clinical guidelines developed by the National Heart, Lung and Blood Institute and backed by the American Academy of Pediatrics.

The recommendation to universally screen children for a problem associated with the diseases of middle age will may surprise many parents. But because the risk factors and risk behaviors that speed the development of cardiovascular disease (CVD) begin in childhood, preventive care needs to begin early in life as well, according to members of an expert panel tasked with writing the guidelines.

“Atherosclerosis begins in youth, and this process, from its earliest phases, is related to the presence and intensity of the known cardiovascular risk factors,” the authors wrote. In a paper on the guidelines published online Friday in the journal Pediatrics, they summarize their exhaustive review of the clinical evidence supporting such early cholesterol tests for children.

According to the panel, research indicates that:

• Abnormal lipid levels in childhood are associated with “increased evidence of atherosclerosis” later in life.
• Identifying and controlling dyslipidemia in childhood reduces clinical CVD risk into adolescence and young adulthood.
• Patients who undergo cholesterol screening during late childhood are likely to receive similar results in their 30s and 40s.
• Due to normal changes in cholesterol that occur during puberty, the period just prior to puberty onset is “a stable time for lipid assessment.”
• Previous guidelines recommended screening only for children with a family history of early CVD or cholesterol disorders. Because family history is difficult to assess accurately, this method misses 30% to 60% of children with dyslipidemia.
• Non-HDL cholesterol is a strong predictor of persistent dyslipidemia and subsequent atherosclerosis. Because it can be accurately calculated in nonfasting state, non-HDL is an ideal screening tool for identifying risk in children.
• High cholesterol in the presence of obesity is the most common dyslipidemic pattern seen in childhood, and screening overweight and obese children could substantially lower overall risk.
• Because many diseases that cause dyslipidemia also increase patients’ risk of developing atherosclerosis, screening children with these conditions would help manage that risk.
• In patients with inherited high cholesterol, hallmark signs of the condition may not manifest until adulthood. Screening these patients early in life will lead to early detection of abnormalities.

For these reasons, the National Heart, Lung and Blood Institute recommends universal screening for all children beginning at age 9. The panel also recommends health providers begin taking yearly blood pressure measurements beginning at age 3, providing anti-smoking counseling between the ages of 5 and 9, and tracking body mass index at age 2, the Associated Press reported.

As for the question of whether the new screening guidelines screening are likely to stir controversy among parents, Associated Press quoted panel member Elaine Urbina, MD, of Cincinatti Children’s Hospital Medical Center: “If we screen at age 20, it may already be too late. To me, it’s not controversial at all,” she said. “We should have been doing this for years.”

For other articles in this issue, see:

• IMS: Drug Shortages Highly Concentrated
• Medco Plans to Block Generic Lipitor