Should family physicians routinely screen for hypercholesterolemia in children? Yes: the evidence supports universal screening

In adolescents with familial hypercholesterolemia, statin treatment has been shown to slow the progression of atherosclerosis.2,3 One concern with universal lipid screening in children is that medications would be indicated in many healthy children, especially those who are obese. Because the dyslipidemia of obesity is characterized by elevated triglyceride levels and reduced HDL cholesterol levels, with little increase in total or LDL cholesterol levels, large numbers of healthy children should not need medication.2,3 According to National Health and Nutrition Examination Survey data from 1999 to 2006, less than 1 percent of the screened adolescents would be candidates for medication.14 Evidence is lacking on the long-term safety and effectiveness of cholesterol-lowering therapy in childhood, and on the cost of case finding. Findings from other kinds of studies can amplify the evidence, and these studies are a priority for further research.15 The evidence is clear: severe cholesterol elevation starting in early childhood is associated with cardiovascular disease, and therapy to lower LDL cholesterol is safe and effective in risk reduction. Because selective screening is ineffective, universal screening before puberty is the only way to identify children with extreme cholesterol abnormalities who will benefit most from treatment. [...]childhood is an important time to optimize cardiovascular health because it is when health behaviors develop, risk factors manifest, and risk reduction will have the greatest impact.