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Family history evaluation as a predictive screen for childhood hypercholesterolemia. Pediatric Practice Research
T C Griffin1, K K Christoffel, H J Binns
1Department of Pediatrics, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois 60614.
Insights
Family history screening is ineffective for identifying childhood hypercholesterolemia. Inclusive population screening is recommended over family history-based strategies for better detection of elevated low-density lipoprotein-cholesterol (LDL-C).
Area of Science:
- Pediatric Cardiology
- Preventive Medicine
- Biochemistry
Background:
- Childhood hypercholesterolemia is a significant risk factor for early-onset cardiovascular disease.
- Current screening guidelines often rely on family history, but its effectiveness is debated.
- Early identification of elevated cholesterol levels in children is crucial for timely intervention.
Purpose of the Study:
- To evaluate the efficacy of family history factors as screening criteria for childhood hypercholesterolemia.
- To compare the effectiveness of family history-based screening with inclusive population screening for detecting elevated low-density lipoprotein-cholesterol (LDL-C).
Main Methods:
- A cohort of 1005 prepubertal children underwent random serum cholesterol determinations.
- Parental and grandparental histories of cardiovascular risk factors and atherosclerotic complications were collected.
- Children with elevated total cholesterol were retested, and low-density lipoprotein-cholesterol (LDL-C) levels were analyzed.
Main Results:
- Maternal and paternal hypercholesterolemia histories showed association with elevated LDL-C but had very low sensitivity.
- Grandparental histories of cardiovascular events were also associated with elevated LDL-C but lacked predictive value.
- Family history criteria identified less than half of children with elevated LDL-C and did not pinpoint the most affected.
Conclusions:
- Family history factors are insufficient for effectively screening childhood hypercholesterolemia.
- Adding childhood obesity data did not significantly improve LDL-C detection rates.
- Inclusive population screening is the most effective strategy for identifying young children with elevated LDL-C.
Abstract:
A study was conducted to evaluate the efficacy of family history factors as screening criteria for childhood hypercholesterolemia. When they were seen for routine care at one of eight office practices, 1005 prepubertal children underwent random serum cholesterol determinations. Parental and grandparental histories of cardiovascular risk factors and atherosclerotic complications prior to 55 years of age were also obtained. Of the initial group, 274 children had total cholesterol levels greater than or equal to 175 mg/dL, and 175 of these children returned for retesting after an overnight fast. A total of 88 children were found to have low-density lipoprotein-cholesterol (LDL-C) values greater than or equal to 90th percentile for age and sex. Maternal and paternal histories of hypercholesterolemia were significantly associated with elevated LDL-C (odds ratio = 7.3 and 2.9, respectively), but had extremely low sensitivities (0.09, 0.15) despite modest positive predictive values (0.42, 0.22). Grandparental histories of sudden death, peripheral vascular disease, and gout were associated with elevated LDL-C, but sensitivities and positive predictive values for all of these factors were less than 0.22. Family history factors most commonly recommended as criteria for cholesterol screening in children did not identify half of all the children with elevated LDL-C and did not selectively identify the most severely affected children. Adding information concerning the presence of childhood obesity did not result in appreciable improvement in LDL-C detection beyond that achieved by family history factors alone. It was concluded that if thorough identification of young children with elevated LDL-C is desired, inclusive population screening rather than a family history-based strategy would be the most effective approach.