New Guidelines Urge Cholesterol Check for All Kids Ages 9 to 11

FRIDAY Nov. 11, 2011 -- All U.S. children between the ages of 9 and 11 should be screened for high cholesterol, according to new guidelines endorsed by the nation's leading group of pediatricians.

The recommendations are a major shift from current guidelines that suggest such testing be done only for children who have a family history of heart disease or high blood cholesterol, which is one of the major risk factors for heart disease.

Meant to improve children's heart health and reduce their future risk of cardiovascular disease, the new guidelines also recommend that children and young adults have their cholesterol levels checked again between the ages of 17 and 21.

In addition to more widespread screening for cardiovascular trouble at younger ages, the guidelines suggest parents make healthy lifestyle choices for their children, such as breast-feeding, a diet low in saturated beginning at age 1, regular physical activity and protecting children from tobacco smoke.

Cardiovascular disease is rare in children, but risk factors that may be present in childhood can greatly increase the risk of developing heart disease in adulthood, experts note.

The new guidelines were written by a panel sponsored by the U.S. National Heart, Lung, and Blood Institute and are endorsed by the American Academy of Pediatrics (AAP). They will give health-care providers an integrated plan to deal with all the major cardiovascular disease risk factors as part of regular child health visits, according to the AAP.

"The more we learn about heart disease and stroke in adults, the more we know that the process begins in childhood and progresses over time," Dr. Stephen R. Daniels, chairman of the panel that reviewed the guidelines, said in an AAP news release.

"By working with families, we can keep kids at a lower lifetime risk and prevent more serious problems in adulthood," added Daniels, who is head of pediatrics at the University of Colorado School of Medicine.

The cholesterol screening recommendation is a significant change from the previous guidelines released in 1992, which suggested screening only for children with a family history of heart disease or high cholesterol.

In May, the National Lipid Association made a similar recommendation, calling for all children to be screened for high cholesterol when they're 9 to 11 years old. That group also urges that children with a family history of premature cardiovascular disease or elevated cholesterol be screened for cholesterol with a simple blood test as early as age 2.

In January 2010, a report from the U.S. Centers for Disease Control and Prevention found that 20 percent of American children and teens have abnormal lipid levels -- an indication of too much bad (LDL) cholesterol, too little good (HDL) cholesterol or high triglycerides, which are blood fats.

"Obesity may be linked to these high levels," Ashleigh May, an epidemic intelligence service officer with the CDC, said at the time. "Forty-three percent of obese youth are eligible for therapeutic lifestyle counseling, and 22 percent of overweight youth were also eligible. We really need to identify youth early who have these abnormal lipid levels so we can reduce their risk for later heart disease."

The obesity epidemic in the United States has now left one out of three children overweight or obese.

For the widespread screening called for in the new guidelines, doctors can use a non-HDL cholesterol test that does not require children to fast. Children with abnormal results on this test should be followed up with a fasting lipid profile, according to the guidelines.

The widespread screening now recommended should more accurately identify children who are at high risk of cardiovascular disease so doctors can take action to help them, Daniels said.

Lifestyle modifications -- such as a healthier diet and more exercise -- would be recommended for most children with high cholesterol. Less than 1 percent of them would quality for cholesterol-lowering medications such as statins.

The new guidelines will be published online Nov. 14 in the journal Pediatrics and as a supplement to the journal's December print issue.

"We're aware that pediatricians have a long list of things they have to address as part of health promotion and disease prevention. This is really an important part of what should be on that list," Daniels said. "We as pediatricians really need to get kids started on the right track and keep them in as low a risk category as possible."

Dr. Daphne Hsu, chief of pediatric cardiology at Children's Hospital at Montefiore in New York City, said, "Screening children for high cholesterol will identify children who are at risk for coronary disease later -- that's true. But screening without encouraging people to do something about it would be worthless.

"The first approach to lowering cholesterol is always diet and exercise," she said. If screening can help motivate children to lose weight and eat a healthy diet it's worthwhile, she added.

However, Hus doesn't think that children should be taking statins to lower cholesterol.

"The recommendations are not to use statins in children except in a very specific high-risk group of patients with a genetic problem where they have an inability to metabolize cholesterol," she said.

Angela Golden, incoming president-elect of the American Academy of Nurse Practitioners, said: "This screening will provide an opportunity to discuss with each child and family specific lifestyle changes that can improve their lifetime cardiovascular health. Partnering with children at this age in making good lifestyle decisions may provide the best health benefits for life."

Dr. Roya Samuels, a pediatrician at Cohen Children's Medical Center in New Hyde Park, N.Y., added: "Cardiovascular disease (CVD) is a leading cause of mortality among Americans today. Although quite common in the adult population, CVD is a rather rare condition in childhood and adolescence. Measures of prevention during childhood, however, may be very helpful in stopping the development and progression of heart disease later on."

More information

The Nemours Foundation has more about children and cholesterol.

Posted: November 2011


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