Screening Children for Cholesterol

Historically speaking, cholesterol screening did not occur until the patient reached their late twenties, thirties or forties. It was felt that testing anyone less than that yielded little because children, for example, rarely showed evidence of elevated cholesterol. Over the last few years, recommendations have changed and doctors recommend screening for cholesterol as young as age nine years.

It has been shown that high cholesterol in children are good predictors of later heart disease. These children can be taught ways of lowering their cholesterol and, in severe cases, medications can be used to lower the cholesterol and reduce heart disease risk.

These new recommendations have shocked parents who fully expect their children to have normal cholesterol. They don’t recognize that heart disease can begin at a young age and, while heart attacks aren’t found in the youth, the plaque buildup begins at earlier and earlier ages. Over decades, these plaques form dangerous blockages of the arteries so heart disease or stroke is likely. Plaques in children tend to be soft and fatty but later in life harden and become dangerous. Screening is therefore recommended between 9 and 11 years of age—before puberty. This is when cholesterol temporarily dips in normal people.

Diabetes screening is done earlier and earlier; screening test for Body Mass Index is also done because these things lead to heart disease. Diabetes used to be type I exclusively in children but more children are developing type II diabetes, in part because of obesity and bad eating habits. Doctors need to take a strong look at family history in children because these can be predictors of heart disease later in life.

The truth is that children who reach fourth grade have high cholesterol about 10-13 percent of the time. If a child has high cholesterol as a child, he or she will almost always have cholesterol elevations as they age. A third of kids and teenagers suffer from obesity or are at least overweight. Obesity makes diabetes and high cholesterol more likely. Right now, only kids with a strong family history are screened for high cholesterol. Unfortunately, about thirty percent of children with high cholesterol are missed when only family history is considered. Screening at the age of 20 may be too late to make a difference in the risk of heart attack and stroke later in life.

Now, the recommendation is to screen everyone between 9 and 11 so as to catch everyone and intervene before it becomes too late. Even doctors are recommending that their own children be screened at a young age. They also recommend diabetes screening in the teen years and BMI testing in the teen years.

One problem is that there may be children not at risk for heart disease or diabetes who are given a false positive result and who are unnecessarily treated for these conditions when they don’t need to.