Almost a third of kids screened for high cholesterol between the ages of 9 and 11 have borderline or high cholesterol, potentially placing them at greater risk for future cardiovascular disease, according to a Texas-based study.
In what was described as one of the largest studies of outpatient pediatric clinic visits to date, researchers examined the medical records of 12,712 children who had screening for cholesterol levels as part of a routine physical exam within the Texas Childrens Pediatrics Associates clinics, the nations largest pediatric primary care organization.
Of these, 4,709, or 30%, had borderline or elevated total cholesterol as defined by the National Cholesterol Education Program, researchers are scheduled to report at the American College of Cardiologys annual scientific sessions March 29-31 in Washington, D.C.
The sheer number of kids with abnormal lipid profiles provides further evidence that this is a population that needs attention and could potentially benefit from treatment, Thomas Seery, MD, the studys lead investigator, pediatric cardiologist at Texas Childrens Hospital and assistant professor of pediatrics at Baylor College of Medicine in Houston, said in a news release. But we can only intervene if we diagnose the problem.
Although cardiovascular disease in children is rare, the presence of certain risk factors in childhood can increase the chances of developing heart disease as an adult. Previous studies have demonstrated that atherosclerosis can begin in childhood.
We know that higher levels of, and cumulative exposure to, high cholesterol is associated with the development and severity of atherosclerosis, Seery said. If we can identify and work to lower cholesterol in children, we can potentially make a positive impact by stalling vascular changes and reducing the chances of future disease. He said this effort especially is important amid the growing obesity epidemic, which has resulted in a larger population of children with dyslipidemia.
The researchers also found that boys were more likely than girls to have elevated total cholesterol, low-density lipoprotein cholesterol and triglycerides, while girls had lower high-density lipoprotein cholesterol. Obese children were more likely to have elevated total cholesterol, LDL and triglycerides and lower HDL in comparison to non-obese children.
Average total cholesterol, LDL, non-HDL and HDL all were within the normal range: 162 mg/dL, 92 mg/dL, 113 mg/dL and 52 mg/dL, respectively; average triglycerides were borderline or abnormal (103 mg/dL). Similar to a recent, unrelated study of adult minority groups, 9- to 11-year-old Hispanic children in this study were more likely to have elevated triglycerides and lower HDL when compared with non-Hispanics.
Follow the guidelines
The authors said they hope their findings will give added weight to guidelines sponsored by the National Heart Lung and Blood Institute (www.nhlbi.nih.gov/guidelines/cvd_ped/) and endorsed by the American Academy of Pediatrics that call for universal cholesterol screening of children between ages 9 and 11 and again between ages 17 and 21.
Despite these recommendations, some practitioners remain hesitant. There is concern by some in the medical community that children will be started on medication unnecessarily, Seery said, emphasizing that adopting a healthy diet and engaging in routine physical activity are first-line therapies for children with abnormal cholesterol levels.
Seery added that cholesterol-lowering medications typically are needed in 1% to 2% of children with dyslipidemia, primarily in those with very high cholesterol resulting from a genetic lipoprotein disorder. Genetic lipoprotein disorders, such as familial hypercholesterolemia, result in very high cholesterol levels that can be detected in childhood but are felt to be underdiagnosed, he said.
Kids need to have their cholesterol panel checked at some point during this time frame [ages 9 to 11], Seery said. In doing so, it presents the perfect opportunity for clinicians and parents to discuss the importance of healthy lifestyle choices on cardiovascular health. Our findings give a compelling reason to screen all kids blood cholesterol.
Because the universal pediatric screening recommendations were released at the end of 2011, during the second year of this study, Seery said a potential study limitation is the uncertainty of whether testing was ordered in a universal manner or selectively based upon individual risk factors or a family history of premature cardiac disease. Recent studies have demonstrated that screening based on family history alone risks missing a large number of children who have dyslipidemia.
In addition, the study population was limited to the region in and around Houston.
Further research is needed to determine the rate at which primary care providers are following the guidelines since the rollout in 2011, Seery said.