The face of cholesterol testing just got a lot younger.
The American Academy of Pediatrics recently revised guidelines for annual well-child visits, adding a recommendation that all children between the ages of 9 and 11 get a dyslipidemiascreen, which calculates total cholesterol, including high-density lipoprotein ("good" cholesterol, aka HDL), low-density lipoprotein ("bad" cholesterol, aka LDL or non-HDL) and triglycerides in the blood.
It's the result of a 2012 report from the National Heart, Lung, and Blood Institute, which urged the universal childhood test based on evidence that elevated triglycerides and LDL raise the risk of later cardiovascular disease, which afflicts at least 40 percent of the U.S. population. It cited evidence that early intervention can substantially reduce that risk.
The test recommendation has been incorporated into the AAP's Bright Futures Recommendations for Preventive Pediatric Health Care, said Dr. Joseph Hagan, co-editor of those guidelines and a primary care pediatrician in Vermont.
"There are a couple of thoughts behind screening at that age," Hagan said. "One is that, during adolescence, the sex hormones lower cholesterol numbers (by 10 to 20 percent, according to the institute). So you get a number that's harder to interpret. The best time to get a baseline number is before puberty."
In the past, children were tested only if there were red flags such as obesity, diabetes or a family history of heart disease. But studies over time indicated that the risk-assessment questions were failing to identify 30 to 60 percent of disorders, according to the institute.
Rising obesity rates are undeniably a force behind the recommendation, Hagan said. Obesity is commonly associated with elevated triglycerides and non-HDL, and low levels of HDL.
"It is the non-HDL we are concerned with," Hagan said.
The baseline blood draw does not require the child to fast beforehand. The institute considers an acceptable non-HDL result for children and adolescents to be below 120. Borderline is 120-144. High is 145 or above.
Hagan adopted the testing guideline a year ago in his practice.
"We have picked up not a whole lot of kids with high cholesterol, but we've picked up a remarkable cohort with high triglycerides," Hagan said. "One child's triglyceride number was unreportable — something like 700. (Acceptable at that age is below 140.) That child's life has been changed."
Cynics might suspect doctors and pharmaceutical companies want to push statin prescriptions.
"That's not the goal here," Hagan said. "I have put only one patient on statins in a year, and it was a 22-year-old who I still care for who had really failed lifestyle changes."
Exercise and diet changes are the most effective interventions.
"Cholesterol is very sensitive to dietary change, and it makes a bigger difference in kids than adults," he said. "Get them outside. Turn off the technology. Eat less fast food and more salmon. Omega 3s are very good for lowering triglycerides."
At least 60 minutes of moderate-to-vigorous physical activity daily can benefit children's health, according to the institute's report, particularly in tandem with a healthy diet.
Dr. Anita Chandra-Puri, a pediatrician with Northwestern Medicine in Chicago and a spokeswoman for the AAP, said a handful of her patients have shown elevated cholesterol in the past year. She has not prescribed medications.
"Parents are shocked at the thought of checking their child's cholesterol level at the age of 9," she said, "but it is an important piece of information when counseling them about their child's current or potential risk for childhood obesity and cardiac disease. That is a very important part of this process too."
Establishing healthy eating habits
Parents have a new ally in the effort to clean up their kitchens and improve their children's eating habits — and their own.