Screening adolescents for lipid disorders: what is the best approach?

Coronary artery disease is the most common cause of death in the United States and the leading cause of hospital-related health care costs. Hypercholesterolemia is a leading risk factor for cardiovascular disease, and both genetic and environmental factors affect cholesterol levels. Although the clinical symptoms and signs of elevated cholesterol levels in children do not occur until adulthood, arterial dysfunction and plaque formation begin much earlier. Thirty-six percent of US youth have a cholesterol level that is higher than normal (>170 mg/dL), with elevated low-density lipoprotein levels associated with atherosclerotic lesions and ultimate disease. Because the disease process begins in childhood and adolescence, early prevention in childhood is critically important. Currently, universal cholesterol screening of adolescents is the most cost-effective method of identifying individuals with familial hypercholesterolemia who need intensive and early preventive care.