Concerning Number of Children Have High Cholesterol
Washington, DC—One in 3 children undergoing routine lipid screening in primary care pediatric clinics have cholesterol levels considered high or borderline high, potentially placing them at a greater risk for future cardiovascular disease (CVD), according to research presented during an education session at the ACC meeting.
During the session, lead investigator Thomas Seery, MD, pediatric cardiologist, Texas Children’s Hospital, Houston, Texas, assistant professor of pediatrics, Baylor College of Medicine, discussed the study’s findings.
Higher levels of, and cumulative exposure to, high cholesterol is associated with the development and severity of atherosclerosis. Although CVD in children is rare, the presence of hyperlipidemia in childhood can increase the chances of developing heart disease as an adult. Studies have demonstrated that atherosclerosis—a hardening and narrowing of the arteries—can begin in childhood. Recently, there has been a paradigm shift in promoting cardiovascular health in children and adolescents that recommends universal screening for high cholesterol, according to Dr. Seery.
This paradigm shift was highlighted in the 2011 report, “Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents,” published in Neurology. The panel, appointed by the National Heart, Lung and Blood Institute and endorsed by the American Academy of Pediatrics, recommends that children undergo lipid screening for nonfasting, non–high-density lipoprotein (HDL) cholesterol levels or a fasting lipid panel between 9 and 11 years of age, followed by another full lipid screening test between 18 and 21 years of age.
Given the recommendations on screening for cholesterol levels in children 9 to 11 years of age, Dr. Seery and colleagues sought to study the rate of hyperlipidemia and hypertriglyceridemia detected by screening at routine physical examinations in the preadolescent population. Researchers conducted a retrospective chart review of electronic medical records of 12,712 children who underwent a physical examination between January 2010 and July 2013 at the Texas Children’s Pediatrics Associates clinics, one of the largest pediatric care associations in the United States, with more than 40 clinics in the Houston area. For patients who had a lipid panel obtained at the visit, patient age, sex, ethnicity, and lipid results were determined. Of the study population, approximately one-third of patients were obese.
The results found that 30% of children (n=4709) had borderline or elevated total cholesterol, as defined by the National Cholesterol Education Program. The mean body mass index was 19.3 kg/m2. Average total cholesterol, low-density lipoprotein (LDL) cholesterol, HDL cholesterol, and triglycerides were 162 mg/dL, 92 mg/dL, 52 mg/dL, and 103 mg/dL, respectively. Males were more likely than females to have elevated total cholesterol (P<.001), LDL cholesterol (P=.008), and triglycerides (P=.003), but females had lower HDL cholesterol (P<.001). Obese patients were found to have high total cholesterol, LDL cholesterol, and triglycerides, but lower HDL cholesterol compared with nonobese patients. When the researchers examined the ethnic background of the children, they found that Hispanics were more likely to have elevated total cholesterol (P<.001) and lower HDL cholesterol (P<.001), though there were no differences in total cholesterol and LDL cholesterol when compared with non-Hispanics.
“A concerning number of children had an abnormal screening lipid level,” concluded Dr. Seery. “Efforts to educate primary care providers regarding recommendations for universal lipid screening in the preadolescent population are needed to prevent underdiagnosis. Targeted interventions by gender and ethnicity may be needed to alleviate the burden of abnormal lipid profiles.”—Eileen Koutnik-Fotopoulos
