II. Health Supervision

Laboratory Tests: Cholesterol Screening

Risk assessment is a primary strategy in early identification of high cholesterol, a major factor in the development of coronary heart disease. All children and teens in the District need to be assessed at each preventive health visit from ages 3 to 21 years to determine their risk of developing high cholesterol.

Risk Assessment

Risk assessment to identify high cholesterol levels is based on:

• Comprehensive physical exam
• Family history*
• Other risk factors (e.g., obesity, diabetes, smoking)

Risk Factors for High Cholesterol

Parent or grandparent with diagnosed coronary artery disease < 55 years of age, based on angiography Parent or grandparent with documented myocardial infarction, angina pectoris, peripheral vascular disease, cerebral vascular disease, or sudden cardiac death < 55 years of age Family history unknown* Parent's blood cholesterol > 240 mg/dl Other risk factors (obesity, smoking, poor dietary habits, elevated blood pressure, diabetes mellitus) *When family health history is unknown, child/teen is considered at risk.

Periodicity and Guidelines for Cholesterol Screening

HealthCheck recommends cholesterol screening as follows:

Childhood and Adolescence:

• Assess risk at each preventive health visit from 3 years to 21 years of age
• If child or teen at high risk: Screen with a blood test if indicated
  

Screening Methods

When the physical exam, family history, and/or other factors indicate that the child or teen is at high risk, screen with an initial blood test to measure total cholesterol (TC). If TC > 200 mg/dl, perform a fasting lipoprotein analysis to measure high-density cholesterol (HDL-C) and low-density cholesterol (LDL-C).

Evaluation and Management

The following table classifies TC and LDL-C levels:¹

The American Academy of Pediatrics' recommendations for cholesterol management include the following:

If LDL-C level is in the acceptable range:
• Provide health education on eating patterns and on other risk factors
• Repeat test in 5 years

If LDL-C level is borderline:

• Advise about risk factors for cardiovascular disease
• Initiate the American Heart Association low-fat diet and other risk factor interventions
• Repeat test again in 1 year

If LDL-C level is high:

• Examine for secondary causes (thyroid, liver, and renal disorders) and familial disorders
• Screen all family members
• Initiate American Heart Association low-fat diet

¹American Academy of Pediatrics, Committee on Nutrition. 1998. Cholesterol in childhood. Pediatrics 101(1):141-147.

Resources

Green M, Palfrey JS, eds. Bright Futures: Guidelines for Infants, Children, and Adolescents (2nd ed., rev.). (Appendix H: Hyperlipidemia Screening.) 2002. Arlington, VA: National Center for Education in Maternal and Child Health. Available online at www.brightfutures.org.