Among West Virginia fifth-graders with no family history of premature hyperlipidemia or cardiovascular disease, and therefore not currently recommended for cholesterol screening, 9.5% had LDL levels of 130 mg/dL or higher, according to a study published in the August issue of Pediatrics.
That rate was slightly higher than the prevalence in those who did meet published criteria for screening, reported Susan K. Ritchie, RN, MPH, of West Virginia University in Morgantown, W.Va., and colleagues.
The researchers had screened all fifth-graders attending public schools in West Virginia, a total of 20,266 children, regardless of whether they had any risk factors for coronary artery disease.
They also found that 1.7% of those with no family history had LDL levels of at least 160 mg/dL, which would warrant drug treatment under current guidelines.
"If cholesterol testing had been limited to those with a family history of premature cardiovascular disease or premature hyperlipidemia, then one-third of children who met criteria for pharmacologic treatment would have been missed," Ritchie and colleagues wrote.
"Universal cholesterol screening in the pediatric population will allow early diagnosis and appropriate treatment of children with significant dyslipidemia secondary to genetic and/or adverse lifestyle factors, hopefully preventing arterial disease."
Of all the children screened, 14,468 met current guidelines for screening, issued by the National Cholesterol Education Program (NCEP) in 1991.
Those guidelines call for screening of those with family histories suggesting special risk for hyperlipidemia. That includes those whose:
- Parents or grandparents had documented coronary artery disease before age 55
- Mother or father had a total cholesterol of at least 240 mg/dL
- Family history was unknown
The remaining 5,798 children did not meet any of these criteria.
Ritchie and colleagues found that 1,204 (8.3%) of those meeting at least one of the NCEP criteria had LDL levels of at least 130 mg/dL, and 170 (1.2%) had levels of at least 160 mg/dL.
Targeted screening based on the NCEP criteria had a sensitivity of 63% (95% CI 0.57 to 0.69) and a specificity of 30% (95% CI 0.28 to 0.33) for identifying those in need of drug treatment, the researchers calculated.
In the entire sample, 268 children were found to have LDL levels above the treatable threshold, 98 of whom were in the group not meeting NCEP criteria for screening.
"Using family history does not provide strong indication as to whether pharmacological treatment is warranted," Ritchie and colleagues wrote.
Other physicians contacted by MedPage Today and ABC News agreed that universal screening of children may be a better idea.
Goutham Rao, MD, of the University of Pittsburgh, noted that a "large proportion" of children should already be screened under current recommendations.
"Expanding this proportion to 100% would not be burdensome to the healthcare system, especially with newer point-of-care devices which can measure lipid levels within a few minutes," Rao wrote in an e-mail.
But Miriam Labbok, MD, MPH, of the University of North Carolina, was not so sure.
"My primary concern is that it would be used to support increased, possibly unnecessary, medication during childhood, rather than being used to support exercise in schools and diet modification," she said in an e-mail.
Labbok also recommended infant breastfeeding as a preventive measure, insofar as previous research has found that it reduces risks of many chronic diseases later in life.
Ritchie and colleagues noted that universal child screening could also increase the detection rate of hyperlipidemia in adults, as parents and older siblings of children found to have elevated LDL may themselves seek screening as a result.
Such a ripple effect of universal child screening "could lead to the prevention of premature cardiac events in adults that may have otherwise gone undiagnosed," the researchers wrote.
They did not list specific limitations of the study, but the racial makeup of West Virginia (low proportions of Hispanics and African Americans) differs from the national average. The state also has higher-than-average rates of obesity and diabetes among children and adults as well as a high prevalence of coronary artery disease in adults.
This article was developed in collaboration with ABC News.
Ritchie and colleagues declared they had no relevant financial relationships.
Rao and Labbok declared no relevant financial relationships.
- Reviewed by Dori F. Zaleznik, MD Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner