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Should All Children and Teens Be Screened For High Cholesterol?

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September 22, 2016

According to the U.S. Preventive Services Task Force (USPSTF), not enough evidence exists currently to recommend for or against routine screening for high cholesterol in all youths. The Task Force, an independent, volunteer panel of national experts in prevention and evidence-based medicine, recently reviewed and released its guidance on cholesterol testing in children and teens.

The guideline applies to youths with no known risk factors for heart disease. Screening with a lipid profile is recommended for those who have risk factors, such as diabetes, high blood pressure, or being overweight.

In contrast, the 2011 guidelines from the National Cholesterol Education Program (NCEP), then a division of the National Institutes of Health, recommended routine cholesterol screening for all children and young adults. Specifically, they recommended that all children between the ages of 9 and 11 be screened once and then have additional lipid testing between the ages of 17 and 21. The American Academy of Pediatrics (AAP) endorses recommendations for universal screening.

The USPSTF evaluated this topic because of a concern that youths with high cholesterol are more likely to have high cholesterol levels as adults, which can lead to an increased risk of heart attacks and strokes.

To reach its decision, the Task Force looked at research studies conducted on high cholesterol in children caused by genetics, or family history, as well as high cholesterol caused by a combination of factors, such as a high fat diet. The data available from current studies are not sufficient to recommend for or against routine screening, concluded the Task Force, because:

  • The evidence showed it was difficult to predict which children with high cholesterol would continue to have the condition as adults.
  • The evidence did not indicate whether testing for and treating high cholesterol in children and young adults would lead to better cardiac health when those children became adults.
  • There is a lack of evidence on potential harms from the medications used to treat high cholesterol in children and teens.

"By issuing an "I" (for "insufficient") statement, we are calling for more research to better understand the benefits and harms of screening and treatment of lipid (high cholesterol and triglycerides) disorders in children and teens and on the impact these interventions may have on their cardiovascular health as adults," said David Grossman, M.D., M.P.H, the vice chair of the Task Force. Dr. Grossman is also a professor of health services and an adjunct professor of pediatrics at the University of Washington.

The AAP, which currently endorses universal screening, is evaluating the current research and could release an updated statement in a year or two, says Steven Daniels, MD, PHD, chair of the department of pediatrics at the University of Colorado School of Medicine as well as chair of the AAP's committee on nutrition.

Meanwhile, parents of children and teens who have questions should have a conversation with their healthcare practitioners to help make decisions about cholesterol testing.

"In the absence of evidence, health care professionals should continue to take each patient's individual risks and circumstances in consideration, and use their best judgment when deciding whether or not to screen," said Dr. Grossman.

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used. To access online sources, copy and paste the URL into your browser.

(August 9, 2016) U.S. Preventive Services Task Force Issues Final Recommendation Statement on Screening for Lipid Disorders in Children and Adolescents. Available online at http://www.uspreventiveservicestaskforce.org/Announcements/News/Item/final-recommendation-statement-screening-for-lipid-disorders-in-children-and-adolescents. Accessed August 28, 2016.

(August 9, 2016) Screening for Lipid Disorders in Children and Adolescents. US Preventive Services Task Force Recommendation Statement. JAMA, Vol 316, No. 6. Available online at http://jama.jamanetwork.com/article.aspx?articleid=2542642. Accessed August 28, 2016.

(May 24, 2016) Rabin, Roni Caryn. Ask Well: Should You Fast Before a Cholesterol Test? The New York Times. Available online at http://well.blogs.nytimes.com/2016/05/24/ask-well-should-you-fast-before-a-cholesterol-test/. Accessed August 28, 2016.

Dr. Steven Daniels, phone communication about AAP cholesterol testing recommendations, August 30, 2016.