July 12, 2010 — One in three children with dangerously high cholesterol is missed by current screening recommendations, a new study suggests.

Kids with LDL “bad” cholesterol levels of 160 mg/dL or higher are at risk of type 2 diabetes and heart attacks in early adulthood, notes William Neal, MD, professor of pediatrics at West Virginia University, Morgantown.

Such children need medical attention. Those with a genetic tendency for very high cholesterol — about one in 500 kids — need treatment. To find them, it’s recommended that pediatricians offer cholesterol screening to kids whose parents or grandparents have very high cholesterol and/or heart disease. But not all of these kids actually get tested.

“A lot of parents told us they didn’t even know kids had cholesterol, let alone high cholesterol,” Neal tells WebMD.

Screening Children for High Cholesterol

So Neal and colleagues offered comprehensive screening, including blood cholesterol tests, to every fifth-grade child in West Virginia.

Surprisingly, more than 70% of the 20,266 kids who were screened would have qualified for routine cholesterol screening, according to current National Cholesterol Education Program (NCEP) guidelines. But even more surprising was how many kids had high cholesterol even though they would not have qualified for routine screening.

“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 says.

For children ages 2-19, a normal level of LDL cholesterol is under 130 mg/dL.

Among the 11-year-olds who met current cholesterol screening guidelines:

• 8.3% had LDL cholesterol levels of 130 mg/dL or higher.
• 1.2% had LDL cholesterol levels of 160 mg/dL or higher

Among the 11-year-olds who would not have been screened under current guidelines:

• 9.5% had LDL cholesterol levels of 130 mg/dL or higher.
• 1.7% had LDL cholesterol levels of 160 mg/dL or higher

Neal says that when child cholesterol screening guidelines were established in the 1990s, it was thought that about 25% of kids would qualify for screening.

“But 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 says. “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.”

Do All Children Need to Be Checked for Cholesterol?

Neal believes it would be a good idea for pediatricians to test all children for high cholesterol. But American Heart Association President Ralph Sacco, MD, chair of neurology at the University of Miami, isn’t so sure.

“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,” Sacco tells WebMD. “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.”

Screening, Sacco says, isn’t enough. What should be universal for kids is a healthier diet and a lot more exercise.

“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 says. “Those would be universal programs we would gladly adopt.”

Sacco and Neal agree that children whose cholesterol does not get lower despite changes in lifestyle may need treatment with cholesterol-lowering statin drugs. Such drugs appear to be safe for children who need them, although treatment of children should begin at very low doses.