May 2007: Volume 33, Number 5
AHA Expands Lipid Screening for Overweight Kids
Hoping to catch children at risk of developing cardiovascular disease, a new scientific statement from the American Heart Association (AHA) proposes that more children be screened for lipid disorders. AHA’s statement, published online in Circulation on March 21 (2007, doi:10.1161 / CIRCULATIONAHA.107.181946), expands the National Cholesterol Education Program’s (NCEP) 1992 recommendations that focused screening efforts on children with a family history of lipid disorders. The new AHA statement recommends that overweight and obese children also receive fasting lipid profiles and screening for other aspects of the metabolic syndrome, such as insulin resistance, type 2 diabetes, hypertension, and central adiposity.
Among children with high-risk lipid abnormalities, NCEP had recommended drug therapy for children whose LDL levels remain ≥190 mg/dL and also suggested medication for children with LDL levels ≥160 mg/dL, a family history of premature CVD, and two or more other risk factors that persist after treatment. AHA now suggests that additional risk factors and high-risk conditions may warrant lowering these cutpoints or beginning drug therapy in children younger than 10. These risk factors include male gender, smoking, history of cigarette smoke exposure, and emerging cardiac markers such as CRP. On the list of high-risk conditions are low HDL, high triglycerides and small dense LDL, aspects of the metabolic syndrome, hypertension, and other medical conditions associated with atherosclerotic risk.
AHA issued its statement because research findings made since 1992 show that CVD occurs earlier and in more children than previously known. “It has become clear that atherosclerotic cardiovascular disease begins in childhood and is progressive. This provides the strongest rationale for aggressive treatment of risk factors in individuals at greater risk for cardiovascular disease at an earlier age,” the statement explained. While the NCEP panel estimated that 25% of children and adolescents should receive lipid screening, more recent population-based studies report that between 36% and 46% of children meet the criteria for testing, the statement points out.
The report also notes that race, gender, and sexual maturation can impact total cholesterol and HDL. “This has an important impact of the sensitivity and specificity of screening,” explains AHA, noting that NCEP guidelines did not take into account these factors into account.