From Our 2011 Archives
A Wake-Up Call: All Children Should Be Tested for High Cholesterol
Expert Panel Presents Heart Disease Prevention Strategies for Children
By Matt McMillen
Reviewed by Hansa D. Bhargava, MD, FAAP
Nov. 11, 2011 -- When you look at a child, you don't think heart disease. But in a sign of the times -- these obese times -- new guidelines today are urging that all children between the ages of 9 and 11 be screened for high cholesterol.
In addition, the guidelines call for the same children to again be screened between the ages of 17 and 21.
Why? Because keeping children's cholesterol in the healthy range may help prevent the onset of heart disease later in life.
High cholesterol is a chief cause of atherosclerosis, or hardening of the arteries, a major cause of heart disease.
The new recommendation that all children be screened is the most significant change to existing guidelines, which were established in 1992 and which called for cholesterol tests only for children with a family history of high cholesterol and heart disease.
"That old approach missed children who had high cholesterol," says guidelines contributor Steve Daniels, MD, PhD, a professor of pediatrics at the University of Colorado School of Medicine.
Daniels says the fatty streaks that signal the onset of atherosclerosis can appear in the first decade of life. If left unchecked, they will progress to dangerous fatty buildups that can clog up and harden arteries in adulthood.
Address the Risks Early
Heart disease in children is quite rare, the report points out, but it is the period during which the risk factors for heart disease begin to develop.
"When I talk to parents, one of the first things I say is that we are not trying to prevent heart disease in childhood; instead, we are trying to lower their long-term risk," says Daniels, who led the expert panel, which was convened in 2006 under the sponsorship of the National Heart, Lung and Blood Institute. Its recommendations are endorsed by the American Academy of Pediatrics and published online in Pediatrics.
Cholesterol testing is only one part of the new guidelines. Daniels and his fellow panelists also provide evidence-based recommendations for heart-healthy lifestyles, as well as for regular blood pressure and BMI (body mass index) checks.
"Our guidelines are really comprehensive and integrative," Daniels tells WebMD. "We considered all risk factors together and designed the guidelines to be useful in an age-specific way."
Daniels says that eating a healthy diet, getting plenty of exercise, and avoiding smoking are among the lifestyle factors that will help kids maintain a "low-risk status" throughout childhood, adolescence, and early adulthood. And doing so will greatly lower the risk of future heart problems.
"If you can make it to 45 or 50 without risk factors, it's very unlikely that you will have heart disease," says Daniels. "This is another part of the rationale for the new guidelines -- to help maintain that low-risk status."
Cleveland Clinic pediatrician Ellen Rome, MD, MPH, says parents should view the guidelines as a wake-up call to make necessary lifestyle changes that will benefit both them and their children.
"If parents don't know their child is at risk, they tend to take recommendations less seriously," says Rome, who was not a member of the panel that produced the guidelines. "Now, they will be more likely to say, 'Wow, we really do need to stop going to McDonald's five nights a week and start eating meals at home.'"
Rome sees cholesterol testing as a burden-free screening tool. Although several doctors on the guidelines panel received consulting fees or had other financial ties with pharmaceutical companies that make statins, including Daniels, both she and Daniels want to reassure parents that kids found to have high cholesterol will not be put on cholesterol-lowering medications.
"Most pediatricians will not be resorting to statins," says Rome.
SOURCES: Steven Daniels, MD, PhD, professor of pediatrics, University of Colorado School of Medicine.Ellen Rome, MD, MPH, pediatrician and head, adolescent medicine division, Cleveland Clinic.Daniels, S. Pediatrics, published online, Nov. 13, 2011.News release, American Academy of Pediatrics.