All tweens aged 9 to 11 should have their cholesterol checked to help head off cardiovascular disease early, according to new medical guidelines announced Friday.
The recommendations, sponsored by the National Heart, Lung and Blood Institute and endorsed by the American Academy of Pediatrics, reflect increasing evidence that heart disease and stroke in adults is the culmination of a process that begins in childhood.
The recommendation to screen for cholesterol at least once between ages 9 and 11 and again between ages 17 and 21 is a significant change from the original 1992 guidelines, which advised screening children only if they have a family history of heart disease or high cholesterol. “Our previous approach to screening has been shown to not work very well,” says Dr. Stephen Daniels, chair of the department of pediatrics at the University of Colorado School of Medicine, who led the panel that compiled the guidelines.
Doctors hope that addressing cardiovascular risk factors as part of regular well-child visits will result in healthier kids. As a result, the guidelines focus on maximizing cardiovascular health starting with breast-feeding and a diet low in saturated fat as early as age 1. Parents are encouraged to keep their kids physically active and away from tobacco smoke.
Why start so young? Pathology studies have shown that the process of atherosclerosis — hardening of the arteries — begins in childhood and progresses over time. “We’ve learned that risk factors we’re used to thinking of as problems in adults are already at work in childhood,” says Daniels.
Prevention works, says Daniels: people who reach the age of 50 while managing to keep their blood pressure and cholesterol low and not become overweight or obese have a very minimal chance of being diagnosed with heart disease down the road.
“Pediatricians and family physicians need to be thinking about this so that they can maintain this low-risk status in children and adolescents,” says Daniels.
Universal screening, in theory, should tip off pediatricians to those children who are at high risk. Assessing risk factors in childhood should enable doctors to zoom in on those children with genetic reasons for having high LDL, the “bad” cholesterol. (One in 500 people have this genetic tendency.)
It will also help physicians identify those kids who are setting themselves up for an unhealthy future. “These are kids who are not candidates for medication but need lifestyle changes,” says Daniels.
In fact, most children who are found to have high cholesterol won’t be treated with medication. Instead, they’ll be directed to amend their diet and exercise regularly. Fewer than 1% of kids with high cholesterol are anticipated to be prescribed cholesterol-lowering medications.
As for the actual testing, kids will luck out: they won’t have to fast because doctors will first use a test that doesn’t require them to forgo food; those kids with abnormal results will then have to return for a fasting profile.