Cholesterol and Children (cont.)
Screening Children for High Cholesterol
Most parents never know their children's cholesterol levels. Some should. In November 2011 an expert panel recommended that all children (regardless of risk factors) should have fasting cholesterol screening between ages 9 and 11, and again between 18 and 21 years of age. This new guideline is designed to diagnose those children at risk for consequences of elevated cholesterol at an earlier age than previously would have been done. With more adults and children being obese, the likelihood that high cholesterol values will be discovered is to be expected. Hopefully early intervention to a healthier lifestyle will help correct such elevated cholesterol levels. Some critics are less enthusiastic regarding these new guidelines. They counter that there is no absolute evidence that treatment of elevated cholesterol in childhood will have a long-term impact on adult health. They also point out that use of lipid lowering drugs in childhood is controversial. The American Academy of Pediatrics has the following guidelines for screening and treatment:
- The most current recommendation is to screen children and adolescents with a positive family history of dyslipidemia or premature (≤55 years of age for men and ≤65 years of age for women) CVD or dyslipidemia. It is also recommended that pediatric patients for whom family history is not known or those with other CVD risk factors, such as overweight (BMI ≥ 85th percentile, <95th percentile), obesity (BMI ≥ 95th percentile), hypertension (blood pressure ≥ 95th percentile), cigarette smoking, or diabetes mellitus, be screened with a fasting lipid profile.
- For these children, the first screening should take place after 2 years of age but no later than 10 years of age. Screening before 2 years of age is not recommended.
- A fasting lipid profile is the recommended approach to screening, because there is no currently available noninvasive method to assess atherosclerotic CVD in children. This screening should occur in the context of well-child and health maintenance visits. If values are within the reference range on initial screening, the patient should be retested in 3 to 5 years.
- For pediatric patients who are overweight or obese and have a high triglyceride concentration or low HDL concentration, weight management is the primary treatment, which includes improvement of diet with nutritional counseling and increased physical activity to produce improved energy balance.
- For patients 8 years and older with an LDL concentration of ≥190 mg/dL (or ≥160 mg/dL with a family history of early heart disease or ≥2 additional risk factors present or ≥130 mg/dL if diabetes mellitus is present), pharmacologic intervention should be considered. The initial goal is to lower LDL concentration to <160 mg/dL. However, targets as low as 130 mg/dL or even 110 mg/dL may be warranted when there is a strong family history of CVD, especially with other risk factors including obesity, diabetes mellitus, the metabolic syndrome, and other higher-risk situations.
Three factors are linked to cholesterol levels, and all are related to family issues:
- Heredity: whether the child inherited a tendency to have high blood cholesterol
- Diet: whether the child is eating a diet high in fat that leads to high blood cholesterol and heart risk
- Obesity: whether the child is seriously overweight and at risk for coronary heart disease and diabetes
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