Efficacy of targeted screening for childhood hypercholesterolemia in Japan

The aim of this study is to evaluate the efficacy of targeted screening on the basis of the results from the universal screening of Japanese children. A total of 698 children consisting of 348 in the 3rd grade of elementary school (third graders) and 350 in the 3rd grade of junior high school (ninth graders) were enrolled in one local school district, during the period 1985 to 1998. When body mass index was used as the sole indicator, the sensitivity in detecting hypercholesterolemia was 14.3% in the case of third graders, and 14.7% in that of ninth graders. Family history was investigated through a questionnaire inquiring about the history of 6 atherosclerosis-related diseases in 6 relatives. The sensitivity on the basis of family history was calculated as 0% to 54.5%. According to the atherosclerotic index calculated from the measured levels of total and HDL cholesterol, sensitivity of abnormal levels of atherosclerotic index in children was almost the same as those of hypercholesterolemia. Using targeted screening, it was possible to detect only around half or less of the subjects with hypercholesterolemia. With respect to the sensitivity of the screening, universal screening is recommended for detecting hypercholesterolemia in Japanese children.