Three studies investigated the use of various recommended screening indicators in identifying children with hyperlipidemia. The first was a control cohort from a case-control study that applied the National Cholesterol Education Program (NCEP) guidelines for screening in children5 to 501 US males less than 20 years old, and examined the effectiveness of using the recommended 2 major screening indicators (family history of premature cardiovascular disease and parent cholesterol >240 mg/dL) plus 5 discretionary indicators (high-fat/high-cholesterol diet, hypertension, obesity, smoker, steroid/medication).6 If all major and discretionary indicators were applied to the cohort, 96% of the children with LDL greater than 130 mg/dL were identified. However, the individual positive predictive values (PPV; probability of having LDL >130 when a child had a screening indicator) ranged from 6.8% to 20.6%.
The 2 other studies used a cross-sectional design to evaluate family history of premature cardiovascular disease and hyperlipidemia screening indicators in 4183 grade-school children in Taiwan7 and 2217 youths in Quebec.8 Family history performed poorly as a mechanism for identifying children with hypercholesterolemia (total cholesterol >200 mg/dL; LDL >130 mg/dL) (PPV <12.5%7, PPV=7.7%8). More than 75% of the children in the Taiwan study would have been missed using family history as a screen. Both studies concluded that family history as a screening indicator is insensitive and inaccurate, and no more useful than general population screening.
Recommendations from others
Neither the American Academy of Family Physicians or the US Preventive Services Task Force makes a recommendation about screening for hyperlipidemia in this age group.
The American Academy of Pediatrics recommends screening children aged 2 years or older whose parents or grandparents had coronary atherosclerosis at age 55 or younger (defined by diagnostic coronary arteriography, myocardial infarction, angina pectoris, peripheral vascular disease, cerebrovascular disease, or sudden cardiac death). They also advocate screening children of a parent with an elevated blood cholesterol level (total cholesterolra 240 mg/dL or higher) and those whose parental history is unobtainable.9