Panel advises testing children for cholesterol

Children from ages 9 to 11 should be routinely screened for high cholesterol so that action can be taken to avoid the development of heart disease, according to new guidelines from the US National Institutes of Health.

The guidelines, endorsed by the American Academy of Pediatrics, aim to identify early risks that can sharply increase the likelihood of developing heart disease as an adult.

"Convincing parents and kids to change their lifestyle is hard," said Dr. Daphne Hsu, chief of pediatric cardiology at Children's Hospital at Montefiore hospital in New York, who was not involved in crafting the guidelines.

"If you find high cholesterol, it will give you extra ammunition to talk to the family and talk to the children about the need for changes in diet and exercise," Hsu said. She expects cholesterol levels will track with children's weight.

Previous guidelines called for screening only in children with a family history of heart disease or high cholesterol.

The US Centers for Disease Control and Prevention says two-thirds of American adults and 15 per cent of children are overweight or obese, although in some states the rate for children is above 30 per cent.

The updated guidelines also call for cholesterol screening again from ages 17 to 21, as levels tend to dip during puberty.

The US Preventive Services Task Force, also backed by the US government, concluded several years ago there was not enough evidence to recommend for or against routine screening for cholesterol disorders in children or young adults.

The group says on its website there is no evidence that diet or exercise interventions in childhood lead to improved cholesterol profiles or better health outcomes in adulthood.

"That would be great evidence to have, but it is essentially impossible to achieve since you are talking about a 50-year study," said Dr. Stephen Daniels, chair of the expert panel appointed by National Heart, Lung and Blood Institute, or NHLBI, which issued the new guidelines.

'Process begins in childhood'

"The more we learn about heart disease and stroke in adults, the more we know that the process begins in childhood and progresses over time," he said, noting that the guidelines will help identify children genetically predisposed to high cholesterol.

"We as pediatricians really need to get kids started on the right track and keep them in as low a risk category as possible," Daniels said.

The NHLBI noted that less than 1 per cent of children -- mainly those with a genetic problem that keeps them from metabolizing cholesterol -- would qualify for cholesterol-lowering medications.

The guidelines also recommend ways to optimize cardiovascular health, starting with breast-feeding, emphasizing a diet low in saturated fat starting at age 1, encouraging protection from tobacco smoke and regular physical activity.

"Anything that gets kids eating better and exercising more, I am all for," Hsu said. "Most kids are having blood tests in those years anyway. There will be a cost, but it is not going to be prohibitive."

The guidelines are published in the journal Pediatrics and posted online at the NHLBI website.