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[Screening programme for hyperlipidemia in children and adolescents. Prophylactic aspects of atherosclerosis]
1Klinika Pediatrii, Instytut Matki i Dziecka, Kasprzaka 17a, 01-211, Warszawa, Poland. imid@imid.med.pl
Insights
Early identification of high cholesterol in children is crucial for preventing cardiovascular diseases (CVD). Selective cholesterol screening in at-risk families, as recommended by NCEP-Peds, is the most effective approach for early intervention.
Area of Science:
- Cardiology
- Pediatrics
- Public Health
Background:
- Atherosclerotic cardiovascular diseases (CVD), including coronary heart disease (CHD), are leading causes of death globally.
- Key risk factors for atherosclerosis include hypercholesterolemia, hypertension, smoking, and obesity, with disease onset often beginning in childhood.
- Early prevention strategies are recognized as vital for mitigating CVD, yet controversies exist regarding the optimal approach for identifying high cholesterol in children.
Purpose of the Study:
- To evaluate the effectiveness of different strategies for early identification of hypercholesterolemia in children.
- To present the recommendations of the US Expert Panel for the National Cholesterol Education Program for Children and Adolescents (NCEP-Peds) on cholesterol screening.
Main Methods:
- The study discusses three screening options: mass screening, selective screening, and no screening.
- Focus is placed on selective screening for children from families with a history of CVD or hypercholesterolemia.
- NCEP-Peds guidelines for screening eligible children and defining cholesterol level categories are detailed.
Main Results:
- Selective screening in high-risk families is identified as the most acceptable method for early hypercholesterolemia detection in children.
- NCEP-Peds recommends screening children over 2 years old from families with a history of premature CVD, elevated parental cholesterol, or other risk factors.
- Acceptable total cholesterol is below 170 mg/dl, borderline is 170-199 mg/dl, and high is 200 mg/dl or above for at-risk children.
Conclusions:
- Selective cholesterol screening in children, particularly those with a family history of CVD or hypercholesterolemia, is recommended for early detection and prevention.
- The NCEP-Peds guidelines provide a framework for identifying at-risk children and classifying their cholesterol levels.
- Implementing these guidelines can facilitate timely interventions to reduce the long-term risk of atherosclerotic cardiovascular diseases.
Abstract:
Atherosclerotic cardiovascular diseases (CVD), mainly coronary heart disease (CHD) remain the leading cause of death in adult populations of many countries. The following risk factors for atherosclerosis were identified: hypercholesterolemia, hypertension, cigarette smoking and obesity. Scientific reports and epidemiological studies have shown that atherosclerosis begins in childhood. Therefore consensus was obtained that the earlier the prevention begins the better results are achieved. But there are many controversies around early identification of hypercholesterolemia in children. Three options were considered: cholesterol mass screening, selective cholesterol screening and no screening at all. The most acceptable is selective screening performed in children of high risk families (CVD or hypercholesterolemia in the family). It is recommended by the US Expert Panel for the National Cholesterol Education Program for Children and Adolescents (NCEP-Peds). According to the NCEP-Peds, screening should include the following groups: I) children whose parents or grandparents have a history of CVD (under the age of 55 years), 2) children whose parents have a raised blood cholesterol concentration (above 240 mg/dl), 3) children with negative or unknown family history, but having other risk factors (hypertension, obesity, cigarette smoking, high-fat diet). The experts recommend that the examination should be performed in children after the age of 2 years. The NCEP-Peds guidelines set total cholesterol levels in serum for children and adolescents from families at risk, below 170 mg/dl, as acceptable. Total cholesterol level between 170 and 199 mg/dl is classified as borderline and 200mg/dl and above--as high.