Screening, using a fasting lipid profile, is now being recommended for children and adolescents with a family history of high cholesterol and heart disease. The AAP also recommends screening patients whose family history is unknown or those who have other factors for heart disease, including obesity, high blood pressure, or diabetes.
“Overweight children belong to a special risk category of children and are in need of cholesterol screening, regardless of family history or other risk factors,” the report notes. AAP also is calling for the use of reduced-fat dairy products, such as 2% milk, for children as young as 1 for whom overweight or obesity is a concern.
The recommendations state that screening should take place after age 2, but no later than age 10; if a child has values within the normal range, testing should be repeated in 3 to 5 years. Patients <8 years old who have elevated cholesterol readings should focus on weight reduction and increased activity while receiving nutritional counseling.
For children ≥8 years old and who have high low-density lipoprotein (LDL) concentrations, however, the AAP policy states that pharmacologic intervention with cholesterol-reducing medications should be considered. Patients in this category would be those with an LDL concentration ≥190 mg/dL (or ≥160 mg/dL with a family history of early heart disease or ≥2 additional risk factors present or ≥130 mg/dL if diabetes is present).
Some physicians wonder about the wisdom of prescribing statins to children, however.
The AAP report, entitled “Lipid Screening and Cardiovascular Health in Childhood,” replaces its 1998 policy statement on the issue and appears in the July issue of Pediatrics.