One-Third of Children Tested in Texas Have Borderline or High Cholesterol

March 28, 2014

WASHINGTON, DC — One in three children undergoing routine lipid screening in primary-care pediatric clinics have cholesterol levels considered high or borderline high, according to a new analysis[1].

Regarding LDL-cholesterol levels, 46% of children have borderline-high or elevated levels and 44% have HDL-cholesterol levels considered low or borderline low, report investigators.

"Although cardiovascular disease in children is rare, we do know that atherosclerosis has its origins in childhood and that the greatest single predictor of adult hypercholesterolemia is the blood cholesterol level in childhood," said lead investigator Dr Thomas Seery (Texas Children's Hospital, Houston) during a media briefing announcing the results. "The cumulative exposure to high cholesterol is associated with the development and severity of atherosclerosis."

Speaking with the media in advance of the American College of Cardiology 2014 Scientific Sessions , Seery said there has been a "paradigm shift" in terms of how cardiovascular health is promoted in children and adolescents.

This is best highlighted with the 2011 Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. The panel, appointed by the National Health, Lung, and Blood Institute (NHLBI) and endorsed by the American Academy of Pediatrics (AAP), recommends that children undergo lipid screening for nonfasting non–HDL-cholesterol levels or a fasting lipid panel between the ages of nine and 11 years followed by another full lipid screening test between 18 and 21 years of age.

"These guidelines cover the gamut, including guidelines for breastfeeding, diets low in saturated fat starting at the age of one year, reduction of tobacco exposure, and regular physical activity," said Seery.

Given the recommendations on screening for cholesterol levels in children nine to 11 years old, Seery and colleagues accessed the Texas Children's Pediatric Associates primary-care clinics, one of the largest pediatric-care associations in the US. With 45 clinics in the Houston area, the researchers obtained the medical records of 12 712 children who underwent a physical examination between January 2010 and July 2013.

Average total cholesterol, LDL cholesterol, non-HDL cholesterol, and HDL cholesterol were 162, 92, 113, and 52 mg/dL, respectively. Among those screened, 66% of children had normal total-cholesterol levels and 33.7% had borderline or elevated levels. A larger percentage, as noted, had borderline/elevated LDL-cholesterol levels while 46% had elevated triglyceride levels.

Approximately one-third of the patients were obese. Males were more likely than females to have higher cholesterol levels, but females were more likely to have lower HDL cholesterol. Obese patients had a worse lipid profile than nonobese patients. When the researchers looked at the ethnic makeup of the kids, they found that Hispanic children were more likely than non-Hispanic children to have higher triglyceride levels and lower HDL levels.

"Interestingly, this mimics a recent adult study of minority groups showing that Hispanics have higher triglycerides and lower HDL levels," said Seery.

Overall, Seery said that the cholesterol findings, along with the incidence of obesity observed in the review, is concerning and that efforts are needed to educate primary-care providers regarding the recommendations of the expert panel to screen preadolescent children for elevated lipids.

One of the limitations of the analysis, however, is that it was not known how physicians chose to screen patients, despite the panel's recommendations. While some physicians might have elected to screen all their primary-care patients, others might have selected patients for screening based on other risk factors, including obesity or family history. Such a selection bias can influence the findings, noted Seery, and as such it is not possible to generalize the findings to the entire US population of children.

Full results from this study are being presented during ACC 2014 but were released early via a special preconference press briefing, focused on consumer-interest news.

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