Should children and adolescents be screened for high cholesterol?

The importance of detecting high cholesterol in older adults is well understood. But there’s still not enough evidence about lipid disorders in children and adolescents to determine whether they should be routinely screened.

The U.S. Preventive Services Task Force has concluded the evidence is insufficient to assess the balance of benefits and harms of screening for lipid disorders in children and adolescents 20 years or younger. The report appears in the Aug. 9 issue of JAMA.

High cholesterol in individuals 20 years or younger can be caused primarily by genetics, known as familial hypercholesterolemia, or from both genetic and environmental factors, such as a high-fat diet.

“We are calling for more research to better understand the benefits and harms of screening and treatment of lipid disorders in children and teens and on the impact these interventions may have on their cardiovascular health as adults,” Task Force vice chair David Grossman said in a news release.

The Task Force is an independent panel of experts who make recommendations about the effectiveness of specific preventive care services such as screenings, counseling services, and preventive medications.

The task force does, however, recommend screening children who are 6 years and older for obesity and making referrals as needed for counseling on weight management. Helping children improve diet and exercise may also improve heart health.

“Cardiovascular health in young people is important and the goal is to prevent the development of cardiovascular disease as people age,” said Douglas K. Owens, a professor of medicine at Stanford and a member of the task force when the guideline was developed. “But many important questions remain unanswered about how to do so.”

Owens, a leader at Stanford Health Policy, said that for now, physicians should use their clinical judgment when counseling young patients on lipid disorders.

“Research on screening and treatment of lipid disorders in children and teens and the impact of these interventions have on cardiovascular disease in adults should be a high priority,” he said. “The USPSTF suggests that all children and teens eat a healthy diet, maintain a normal weight, and engage in physical activity.”

Recent estimates from the National Health and Nutrition Examination Survey indicate that 7.8 percent of children age 8 to 17 years have elevated levels of total cholesterol (TC) and 7.4 percent of adolescents age 12 to 19 years have elevated LDL-C, or the “bad cholesterol” that can lead to heart disease.

Four editorials related to the recommendation accompanied the report JAMA, including one from physicians from Stanford and UCSF who suggest that the U.S. health-care system should focus more on high-value solutions to major public health concerns such as climate change, poverty, obesity and gun violence.

“The need for clinicians and leaders to focus on sustainability and health-care value has never been greater, and it is likely that policy and community-based interventions will get us there much more quickly than adding more clinic-based interventions that have low value and are wasteful of resources and clinicians’ time,” they wrote.