Cholesterol screening recommended for all children

Physicians should screen all children for cholesterol regardless of whether they have a family history of premature cardiovascular disease, a new Pediatrics study says.

Universal screening would allow early diagnosis and the appropriate treatment of children with significant dyslipidemia, researchers stated. The ultimate goal is to prevent this group from developing atherosclerotic disease when they become adults.

Screening should begin when children are about 5 years old, according to senior author William A. Neal, MD. The frequency of screening depends on the patient's original low-density lipoprotein cholesterol levels and family history. Children should be screened more frequently if they have an LDL level in the abnormal or high range, or if they have a family history of cardiovascular disease before the age of 55.

The American Heart Assn. recommends that LDL cholesterol be less than 100 mg/dl. High LDL levels (160 mg/dl and greater) increase a person's risk of cardiovascular disease and stroke.

Cardiovascular disease is the leading cause of death for both men and women in the U.S. In 2006, about 631,636 people died from the condition, according to the Centers for Disease Control and Prevention's most recent data. Stroke is the third leading cause of death in the U.S.

For the Pediatrics study, researchers examined data on 20,266 West Virginia fifth-graders who had a fasting lipid profile and completed a family history questionnaire between September 2003 and April 2008. The study was posted online in Pediatrics July 12 (link).

The researchers found that 1.3% of the children had LDL levels that were high enough -- at least 160 mg/dl, to warrant medical treatment. But about one-third of them did not report having a family history of premature cardiovascular disease.

Dr. Neal called the finding significant.

"It strongly [supports] the recommendation that all children be screened so you do not miss [an estimated] 36% of children" who might need medical treatment, said Dr. Neal, a pediatric cardiologist and professor of pediatrics at West Virginia University School of Medicine.

The study's universal screening recommendation goes beyond guidelines issued by the American Academy of Pediatrics, the publisher of Pediatrics. The AAP encourages physicians to screen children and adolescents with a family history of dyslipidemia or premature cardiovascular disease. Doctors also should screen patients whose family history is unknown, or those with other risk factors, including obesity, hypertension, cigarette smoking and diabetes.