Changing the Standard of Care: Studies show importance of cholesterol screening in children

For most parents, a cholesterol screening is not likely to be on the list of tests needed during their child’s annual well check. But research is showing that conducting this simple test on children can identify silent risk factors for heart disease and help prevent the early onset of the world’s number one killer.

High cholesterol is a condition that most people associate with middle age or later stages of life; few people realize that the precursors of adult heart disease can develop during early childhood and slowly grow over time. For some, the seeds of heart disease are present from birth. Those who have a family history of early heart attacks or heart disease may have a lipid disorder called Familial Hypercholesterolemia (FH), a genetic disease associated with an over production or inability to clear the “bad cholesterol” from the blood.

“FH is one of the most common inherited diseases, with a greater occurrence than all other congenital defects that newborns are routinely screened for,” said Sean T. Gregory, Ph.D., who has a joint appointment as an assistant professor with the Texas A&M Health Science Center School of Public Health and the Texas A&M Health Science Center College of Medicine.

Although it is a relatively common genetic disorder affecting about 1 in 500 individuals, FH often goes undiagnosed, leaving those with the disorder at a greater risk of developing premature heart disease as young to middle-aged adults and increasing the likelihood they will experience a cardiac event such as a heart attack.

Heart disease is not a concern that most parents have for their children when they visit the doctor, and without knowledge of the risks, parents rarely request lipid screening or testing for their children.

In an effort to change the way both physicians and families manage the treatment and care of children and teens with FH, the National Heart, Lung and Blood Institute and the American Academy of Pediatrics have released specific guidelines or recommended lipid screening:

1. Selective screening of high-risk youth (i.e., those with a family history of premature heart disease, FH or other risk factors including obesity) should take place any time after two years of age. In addition, the guidelines recommend one lipid screening for all children between 9-11 years of age and another between the ages of 17-21. 2. Screening for any other heart disease risk factors such as high blood pressure, diabetes, obesity, tobacco use and/or other risk conditions.

According to Catherine McNeal, M.D., Ph.D., an associate professor at the Texas A&M College of Medicine who is leading a research study on pediatric cholesterol screening, despite these recommendations, very little has changed in the way providers screen children.

“Research shows that large segments of the pediatric care community are still unfamiliar with the recommended guidelines for lipid screening,” said McNeal.

Most coronary artery disease can be prevented with proper diet, regular physical activity, and avoiding tobacco – important values and habits parents should encourage in their children. However, for those with FH or other risk factors, these options may not be enough. Identifying and addressing a child’s individual risk factors can play a major role in the ability to prevent long-term consequences of coronary artery disease.

Cholesterol medications are recommended in children with FH after the age of 10 years; however, long-term studies to evaluate the benefits or potential adverse effects are still lacking in the pediatric population – a problem Gregory and McNeal hope to rectify with their research.

“There is little doubt that FH is consistently one of the risk factors associated with premature cardiovascular disease, and yet in populations worldwide, it remains largely undiagnosed and undertreated,” said Gregory. “The development of innovative and cost-effective ways to identify youth with FH is crucial to forestalling or minimizing the onset of heart disease in adulthood.”