Currently, U.S. medical guidelines recommend cholesterol screening for children whose parents or grandparents suffered from heart disease or very high cholesterol. The purpose of these tests is to detect a relatively rare genetic condition, affecting 0.2 percent of children, that leads to high cholesterol.

When these guidelines were established in the 1990s, doctors estimated that they would qualify one in four children for screening. But with the rising obesity epidemic, says pediatrics professor William Neal of West Virginia University-Morgantown, doctors are increasingly concerned that these guidelines overlook many children who have developed high cholesterol due to lifestyle reasons.

"As time has gone on, one of the indicators that triggers screening is a condition such as high blood pressure or obesity in the child," Neal said. "You may have children for whom the family history of heart disease may not be positive, but their doctors will lean more toward screening as they worry about diabetes in addition to heart disease."

The most recent push for universal screening comes from a study by Neal and colleagues, published in the journal Pediatrics, finding that many children with high cholesterol are missed under current guidelines. The researchers analyzed family histories and blood tests from more than 20,000 11-year-olds in West Virginia.

Based on family history alone, 71 percent of fifth graders already qualified for screening. But the rate of high cholesterol was no lower among children who did not qualify -- meaning that nearly a third of children with high cholesterol were being missed.

"Just as many kids who would not have been screened ended up with severely high cholesterol levels as in the group that did qualify for screening based on family history," Neal said.

A normal cholesterol level in a child between the ages of two and 19 is 130 milligrams per decaliter (mg/dL), while a level above 160 mg/dL is associated with increased risks of heart attacks and Type 2 diabetes by early adulthood. Among children who qualified for screening based on family history, 8.3 percent had cholesterol levels above 130 mg/dL, while 1.2 percent had levels above 160 mg/dL. Among children who did not qualify, 9.5 percent had levels above 130 mg/dL and 1.7 percent had levels above 160 mg/dL.

As a consequence, the researchers are now calling for universal cholesterol screening for all children.

"A lot of parents told us they didn't even know kids had cholesterol, let alone high cholesterol," Neal said.

Children with high cholesterol are eligible for treatment with statin drugs.

Richard Besser, senior health and medical editor for ABC news, said that universal blood screening may well be unnecessary, noting that the study did not control for the effect of obesity. He said that doctors should instead focus on promoting healthy eating and exercise habits as a way to combat childhood obesity without drugs.

Ralph Sacco, president of the American Heart Association, echoed this advice.

"This study does call into question whether family history is a good enough indicator for screening, but whether to jump to universal screening is another question," he said. "The rising epidemic of diabetes means we need to focus on diet, weight control, and physical activity. Putting the emphasis on this for fifth graders would be of utmost importance."

"Maybe we should have more childhood screening of waist circumference, and of how well fifth graders do in controlling their weight and maintaining exercise," Sacco said. "Those would be universal programs we would gladly adopt."

Sources for this story include: http://abcnews.go.com/GMA/OnCall/dr... http://www.cardiosmart.org/News/Def....

Nov. 1, 2010

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