Do all children need a cholesterol test? Troubling news from West Virginia suggests so, where researchers say the current system of screening for high cholesterol misses almost 10 percent of children who are affected because it relies on a family history of heart disease to identify children at risk. About 1 in 500 children have hereditary high cholesterol, which is the most common cause of high cholesterol in children.
Pediatricians and cardiologists have been going back and forth on the question of testing kids' cholesterol for years now; the most recent recommendation from the American Academy of Pediatrics, issued in 2008, calls for fasting cholesterol tests in children starting at age 2 if kids are overweight and/or have a family history of heart disease. But the West Virginians, writing in Pediatrics, think it's time to screen all kids, no matter their risk profile. Their subjects weren't all overweight either, just a group of fifth-graders screened as part of an effort to combat the very high rates of heart disease and obesity in Appalachia. So I called up William Neal, a pediatric cardiologist and professor of pediatrics at West Virginia University, who is one of the authors of the new study, to find out why the call for cholesterol tests for all.
"All children should be tested for cholesterol at some point," probably around age 5, Neal told me, because he thinks the current screening process misses children who already have high cholesterol. In the 20,266 fifth-graders tested as part of his heart disease risk study, 9.5 percent of children who didn't have family history of heart disease had low-density lipoprotein (LDL, the bad cholesterol) over 130 mg/dL, which is considered high cholesterol. He doesn't think that's just because West Virginia has rates of obesity and heart disease much higher than the national average, but because high cholesterol in childhood is almost always hereditary. About 8 percent of the children considered high risk in the West Virginia group turned out to have high cholesterol, about the same percentage as the group without a family history. The high cholesterol wasn't linked to obesity, Neal says, though many of the children in the study were overweight. They may not have been picked up by the family-history screening because their parents are still too young to have symptoms of heart disease, he added. Early-onset heart disease is defined as having had a heart attack requiring hospitalization, bypass surgery, or angioplasty before age 55.
The good news is that of the 10 percent of children with high cholesterol who weren't identified with the family-history test, just 1.7 percent of those kids had cholesterol levels high enough to warrant treatment with statins. (Just last month Consumer Reports released a big report saying that the side effects of cholesterol-lowering statin drugs, particularly muscle pain, make it too risky to give children statins for high cholesterol except in rare cases.) The others could be treated with the nondrug recommendations used for grownups, too: more exercise and healthier eating.
Here are three ways to keep on top of the children and cholesterol question without freaking out:
- Know your family history of heart disease. If a child's parents or grandparents have had high cholesterol or heart attacks before age 55, talk with your pediatrician about whether it's time for a fasting cholesterol test.
- Get all children active for at least an hour a day, which is the latest recommendation from the Centers for Disease Control and Prevention.
- Chow down on fruits, veggies, and whole grains, and go very easy on meats and saturated fats, which raise cholesterol levels.
Cholesterol tests are relatively simple and inexpensive (about $50 a pop), so if you're worried there's no reason not to have a child tested. But focusing on healthy living will reduce risks for the whole family, without the need for a needle stick.