Cholesterol screenings are a well-recognized element of routine health evaluations, particularly for adults; however, their importance in children and adolescents is often overlooked. Many children and teens are not routinely tested for cholesterol levels, and experts believe various factors may contribute to this oversight, resulting in missed chances to identify significant health risks early.
Approximately 20% of adolescents experience cholesterol levels that fall outside the healthy range, according to Dr. Sarah de Ferranti, a pediatric cardiologist at Boston Children’s Hospital. She emphasizes that while not all cases signify a chronic issue requiring medication, adopting a healthy lifestyle can address many cholesterol abnormalities. “Kids definitely are affected by abnormal cholesterol values,” she stated. De Ferranti played a crucial role in shaping the cholesterol guidelines released in 2018 by the American Heart Association and the American College of Cardiology, which recommend screening children once between the ages of 9 and 11 and again between 17 and 21. For those with a family history of early heart disease or high cholesterol, tests as early as age 2 are advised.
Despite these guidelines aligning with the National Heart, Lung, and Blood Institute’s recommendations, cholesterol testing rates among children and adolescents remain alarmingly low. A study published in July revealed that only 11% of individuals aged 9 to 21 had undergone screening. In contrasting figures, over 70% of U.S. adults have had cholesterol screenings within the last five years, demonstrating a marked disparity in health practices across age groups.
Maintaining healthy blood cholesterol levels is essential for cardiovascular health and lowering the probability of heart disease. “Bad” LDL cholesterol can lead to plaque formation in arteries, increasing the risks of heart attacks or strokes, whereas “good” HDL cholesterol helps keep LDL levels in check. A balanced diet low in saturated fats and rich in fiber, coupled with regular physical activity, is crucial for managing cholesterol levels. Federal guidelines recommend that children aged 6 to 17 engage in at least an hour of moderate- to vigorous-intensity exercise daily.
Recent evidence suggests a link between childhood cholesterol issues—often termed lipid disorders—and future cardiovascular diseases in adults. A study in 2023 established a correlation between high childhood cholesterol levels and heightened risks of midlife heart attacks or strokes. Genetic factors can also play a role in cholesterol levels, making early testing essential for identifying inherited conditions, according to Dr. Emily F. Gregory, a pediatric assistant professor at the University of Pennsylvania.
One critical inherited disorder is familial hypercholesterolemia, characterized by significantly high cholesterol levels from a young age. It is estimated that this condition affects about 1 in 250 individuals in the United States, although its prevalence varies across ethnic groups. Alarmingly, fewer than 10% of those with familial hypercholesterolemia receive a proper diagnosis, with many facing heart attacks as young adults, a situation that experts hope to rectify through early screening and intervention.
Barriers to cholesterol testing in children persist, notably the U.S. Preventive Services Task Force’s current position that views the evidence on screening for lipid disorders as insufficient for those under 20 without symptoms. Although this does not imply that testing is harmful, it highlights the lack of robust studies confirming the benefits of universal testing in children and adolescents. Gathering concrete evidence can be a lengthy and costly endeavor. Furthermore, pediatricians face numerous responsibilities during patient consultations, often prioritizing more pressing health concerns over cholesterol testing.
It is important for parents to be proactive about their children’s health. Gregory advises parents to be aware of existing recommendations and discuss cholesterol testing with their child’s doctor, especially if the child is already having blood tests performed. If cholesterol levels are slightly elevated, the first response usually focuses on lifestyle adjustments rather than immediate medication. Effective communication about family health history concerning cholesterol and heart issues is also essential during visits to the pediatrician.
Pediatricians should recognize the significance of cholesterol tests for their young patients and remain informed about the evolving recommendations regarding screenings. “There is an increasing consensus regarding the necessity for testing,” de Ferranti noted. She highlights the growing body of evidence linking childhood cholesterol issues with adult cardiovascular diseases and the urgency to boost screening rates.
Expert opinions on cholesterol screening in children have differed for years, but Gregory encourages healthcare providers to stay updated on the latest guidelines and research findings. “It’s vital for families to understand the rationale for screening,” she states, stressing the importance of engaging in conversations about cholesterol management. The path ahead holds promise for increased awareness and testing in the pediatric population, potentially mitigating future health issues arising from cholesterol-related conditions.