Although elevated cholesterol levels are generally considered an adult problem, a new study suggests that current screening guidelines for cholesterol in children miss many kids who already have higher cholesterol levels than they should.
The study found that almost 10 percent of children who didn't fit the current criteria for cholesterol screening already had elevated cholesterol levels.
"Our data retrospectively looked at a little over 20,000 fifth-grade children screened over several years. We found 548 children - who didn't merit screening under current guidelines - with cholesterol abnormalities. And of those, 98 had sufficiently elevated levels that one would consider the use of cholesterol-lowering medications," said Dr. William Neal, director of the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project at the Robert C. Byrd Health Science Center at West Virginia University.
"I think our data pretty conclusively show that all children should be screened for cholesterol abnormalities," he added.
Results of the study will be published in the August issue of Pediatrics, but will appear online July 12. Researchers said they had no financial relationships relevant to the report to disclose.
The current guidelines from the National Cholesterol Education Project recommend cholesterol screening for children with parents or grandparents who have a history of premature heart disease - before age 55 - or those whose parents have significantly elevated cholesterol levels - total cholesterol above 240 milligrams per deciliter (mg/dL) of blood. NCEP guidelines also recommend screening for children whose family history is unknown, particularly if they have other risk factors such as obesity.
When these guidelines were developed, experts thought that about 25 percent of U.S. children would meet the screening criteria. However, in the new study, 71.4 percent of children met the screening criteria.
Going into the study, experts knew that the guidelines might miss some children with elevated cholesterol, but there were concerns about labeling children with a pre-existing condition at such a young age. And there was concern that medications might be overprescribed to children. Also, there were concerns about the cost of universal screening, according to the study.
The CARDIAC Project began in 1998 as a way to identify children who were at risk of developing coronary artery disease through free screenings conducted at school. Since its inception, the study has screened 20,266 fifth-graders from all over West Virginia.
From that group, 71.4 percent met the current screening guidelines, and 8.3 percent (1,204 children) were found to have abnormal fat levels in the blood that included low-density lipoprotein (LDL or the "bad" cholesterol) levels above 130 mg/dL, and 1.2 percent had levels equal to or above 160 mg/dL. When LDL levels reach 160 mg/dL or higher, medication may be considered, Neal said.
Abnormal blood fat levels
Among the remaining 28.6 percent of children who didn't meet screening guidelines, and presumably weren't at high-risk for elevated cholesterol, 9.5 percent had abnormal blood fat levels that included high cholesterol, and 1.7 percent were above the threshold for possible cholesterol-lowering medication use, the study found.
Although West Virginia's population is somewhat heavier than the national average, Neal said he believes these findings would likely be similar in other parts of the country. He said in children, genes play more of a role in cholesterol levels than lifestyle factors do.
Not everyone agrees that all children should have cholesterol screening, however.
"I don't believe in universal screening. I think it should be decided individually - look at the child and their family history and their lifestyle and risk factors," said Dr. Eric Quivers, director of preventative cardiology at Children's Hospital of Pittsburgh.
And, Quivers said that while family history definitely plays a role in the development of high cholesterol, sedentary behavior and a diet full of high-calorie, fatty foods can also affect a child's cholesterol and cardiovascular risk factors.
"There is a genetic as well as an environmental component to cholesterol levels," said Quivers.
In addition, the most widely used cholesterol-lowering drugs - statins - carry certain risks, including the development of a disorder that causes severe muscle damage and in very rare cases can be fatal. Even if children fit the criteria for possible cholesterol-lowering drugs, the first line of defense against high cholesterol, according to the National Cholesterol Education Project, is a change in lifestyle, including regular physical activity, a diet rich in fruits, vegetables and whole grains, and, if necessary, losing weight.
An NCEP expert panel has suggested, however, that cholesterol medications be considered if a child with abnormally high cholesterol is at least 8 years old and has not met therapeutic goals after at least 6 months of following a dietary plan designed to lower cholesterol.