NHLBI panel recommends universal pediatric screening for cholesterol

All children and adolescents should be screened for high cholesterol, and children as young as aged 10 should be considered for treatment with statins.

That’s the latest update from an expert panel convened by the National Heart, Lung, and Blood Institute and endorsed by the American Academy of Pediatrics. New recommendations from the Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report were published in a recent special supplement to Pediatrics.

While manifest atherosclerotic cardiovascular disease (CVD) remains rare in childhood and adolescence, the risk factors and risk behaviors that lead to later disease begin early in life. Strong evidence shows that early intervention can enhance early risk reduction and delay progression toward clinical disease.

Growing clinical evidence shows that cardiovascular risk factors, including elevated cholesterol, can begin in childhood. Based on these findings, the panel recommended that cholesterol screening be a part of periodic well-child visits for all children and adolescents. The panel recommended children at least once between aged 9 and 11 and again at between aged 17 to 21.

Treatment with statins should be considered for children with LDL levels of 190 mg/mL or higher who are aged at least 10 years and have failed at least 6 months of lifestyle management.

“Atherosclerosis begins in childhood and the extent of atherosclerosis is linked directly to the presence and intensity of known risk factors,” the panel wrote. “Early identification and control of dyslipidemia throughout youth and into adulthood will substantially reduce clinical CVD risk beginning in young adult life.”

Prior guidelines recommended cholesterol screening only for children with known risk factors such as a family history of CVD or known elevated cholesterol.