Should Kids Be Screened for High Cholesterol?
Should you or shouldn't you? That's the big question when it comes to cholesterol screening for children and adolescents, and the answer seems far from clear.
In 2007, the United States Preventive Task Force (USPTF), an independent panel of experts, established screening guidelines for lipid abnormalities in children. After reviewing the research, the task force concluded that the evidence was insufficient to recommend for or against routine screening for lipid disorders in infants, children, adolescents, and young adults up to age 20.
Dyslipidemia (abnormal lipoproteins) is strongly associated with a risk of cardiovascular disease in adulthood. Some experts believe that by identifying and beginning lipid-lowering interventions in certain populations, we cardiovascular disease events can be prevented. However, the USPTF said the cardiovascular health risk attributable to dyslipidemia during childhood is unknown. Furthermore, the National Cholesterol Program only recommends selective screening for children with a family history of cardiovascular disease.
In 2010, some physicians called for screening of all children, not just those at risk. Others recommended against screening in light of the USPTF findings and the lack of long-term safety data of statin use (cholesterol lowering drugs) with children.
However, in the fall of 2011, the American Academy of Pediatrics (AAP) endorsed cholesterol screening for all children. The AAP had already lowered its recommended starting age for pharmaceutical intervention in children with abnormal lipids from 10 to eight years old, despite the concerns about statins.
The Centers for Disease Control (CDC) report that very high cholesterol in children may decline without intervention. The CDC found that over time, the differences in cholesterol levels between children shrunk; the largest drop occurred in kids who initially had very high cholesterol. After four years, children's cholesterol levels fell below the minimum thresholds for treatment 60 percent of the time.
The CDC also said cholesterol levels are quite variable over time and an elevated cholesterol level during screening may be an anomaly. It recommended additional measurements to confirm unusually high cholesterol scores.
Furthermore, experts say there is no evidence that starting a 10-year old on cholesterol lowering drugs will prevent heart disease 40 years later.
Kavey, Rae-Ellen W., MD, MPH, Simons-Morton, Denise G., MD, MH, PhD, and de Jesus, Janet M., MS, RD. "Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report." Pediatrics 128 (Supplement 5) (2011). Web. http://pediatrics.aappublications.org/site/misc/2009-2107.pdf
U.S. Preventive Task Force. "Screening for Lipid Disorders in Children." Web. July 2007.http://www.uspreventiveservicestaskforce.org/uspstf07/chlipid/chlipidrs.htm
Joelving, Frederik. "All kids should have cholesterol tests: study." Reuters. Web. 12 July 2010.http://www.reuters.com/article/2010/07/12/us-kids-cholesterol-idUSTRE66B0RG20100712
Joelving,Frederik. "Kids' high cholesterol may drop naturally." Reuters Health. Web. 19 July 2010.NEW YORK http://www.reuters.com/article/2010/07/19/us-kids-cholesterol-idUSTRE66I0VL20100719
Husten, Larry. "Part 1: The National Lipid Association and the FH Guidelines." Cardiobrief. Web. 17 May 2011. http://cardiobrief.org/2011/05/17/part-1-the-national-lipid-association-and-the-fh-guidelines/
Osterweil, Neil. "AAP Revises Cholesterol Screening Guidelines for Children." Medscape Medical News. Web. 11 July 2008. http://www.medscape.com/viewarticle/577424
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