Next time you take your toddler to the pediatrician, there's a chance you may be told she needs to undergo a cholesterol (or lipid) test. Screening children as young as 2 for high cholesterol may seem extreme and unnecessary to you-and it seems extreme and unnecessary to some doctors as well-but evidence shows that this "adult" disease begins in childhood.
The buildup of cholesterol in artery walls (atherosclerosis ) may start long before adolescence and will then progress slowly into adulthood. This has led some health experts to call for widespread cholesterol screenings for children. It's a recommendation that has drawn a lot of controversy. On one side are doctors and researchers who say the efforts can prevent heart disease later in life. On the other side is a group that thinks it's too aggressive an approach.
Pro-Screening: Avoiding Future Problems
For several years, the American Academy of Pediatrics advocated cholesterol screenings for high-risk children over the age of 9. Recently, it revised its recommendations based on 2011 guidelines published by the National Heart, Lung and Blood Institute. Now, it supports a lipid screening for all children between 9 and 11 years of age with a repeat test at 17 to 21 years of age; it also recommends screening for high-risk children who are 2 to 8 years old and 12 to 18 years.
When determining which children are at risk, doctors consider two factors to be most important:
- a child's weight
- family history of high cholesterol or heart disease
They will also look for other factors such as kidney disease, high blood pressure, known use of cigarettes, diabetes, Kawasaki disease, or other medical conditions.
The change in recommendations comes at a time when testing lipid levels in children is much easier than it was in the past. Pediatricians can administer the initial test in the office. For earlier iterations of the test, children couldn't eat for the preceding 12 hours. Today, the initial screenings can be done without children needing to fast. If there's an abnormal result on the initial screening, however, children will need a second screening in which they will need to fast.
Supporters of the new guidelines say that there are no drawback and only potential payoffs. Specifically, the new screening process will allow doctors to identify a child who has an LDL cholesterol level of 130 mg/dL or greater so that parents can work with the doctor to get the cholesterol under control. Managing the problem now, they believe, will reduce the risk of heart disease later in life.
Anti-Screening: A Healthy Lifestyle Now, Screening Later
What could possibly be bad about trying to stave off heart disease? Opponents to the new guidelines certainly don't want to see more people suffer the effects of high cholesterol. Their concerns are focused on three main points:
- the new guidelines don't focus on addressing the lifestyle factors that contribute to high cholesterol
- there may be increased use of drug treatments that haven't been proven to be effective in certain circumstances
- the tests are expensive, inconvenient, and haven't been shown to improve outcomes
Critics of universal testing specifically see the screening as a bad way to address the issue of childhood obesity. For instance, using a lipid test to push parents and children to manage weight ignores the fact that more than cholesterol is affected by weight. In a scenario under the new guidelines, a patient and parent might drop a plan of healthy eating and exercise if cholesterol levels go down (even though the child is still overweight and at risk for diabetes and other health problems).
Under the new guidelines, some doctors also anticipate wider use of medications such as statins to control LDL cholesterol levels that could be brought under control through better nutrition and physical activity. They also point out that, other than studies done on children with a specific genetic condition, there isn't good long-term research on the use of statins in treating high cholesterol in children.
Some also say that in a time when the cost of healthcare is getting so much attention and patients are increasingly trying to control their medical bills, it's irresponsible to require them to foot the cost of screenings that haven't been proven effective for protecting children now or in later life.
Sources:
"Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report." PEDIATRICS 128 (2011) 213-256. Web. August 23, 2012.
http://pediatrics.aappublications.org/content/128/Supplement_5/S213.full.pdf+html?sid=30492980-910b-4d93-9117-6bcf4c4b7338
"Children and Cholesterol." American Heart Association. February 8, 2012. Web. August 23, 2012
http://www.heart.org/HEARTORG/Conditions/Cholesterol/UnderstandYourRiskforHighCholesterol/Children-and-Cholesterol_UCM_305567_Article.jsp
