Natural Transitions of Non-High-Density Lipoprotein Cholesterol Levels in Children Aged 9-11 Years

U.S. guidelines recommend universal lipid screening in children aged between 9 and 11 years, with follow-up screening at ages 17-21 years. Non-high-density lipoprotein cholesterol is the preferred marker. However, the stability of non-high-density lipoprotein cholesterol within the screening window remains unclear. This study aimed to estimate the probabilities of non-high-density lipoprotein cholesterol transitioning between its classifications (acceptable, borderline high, and high) during the 9-11-year age period and the average duration that it remains stable within each classification.

This study included 496 Japanese children with non-high-density lipoprotein cholesterol measured between ages 9 and 11 years. Data were collected from 2015 to 2019, and analyses were conducted in 2024. A time-homogeneous continuous-time Markov model was used to estimate the probabilities of transitioning among non-high-density lipoprotein cholesterol classifications-acceptable (<120 mg/dL), borderline high (120-144 mg/dL), and high (≥145 mg/dL)-and the average duration children remained in a given non-high-density lipoprotein cholesterol classification before transitioning.

At the population level, all non-high-density lipoprotein cholesterol classifications identified at age 9 years were estimated to remain stable for more than 2 years. Children with acceptable non-high-density lipoprotein cholesterol had a mean duration of 10.6 years (95% CI=7.8, 14.5) before transitioning to another classification, with an estimated 0.90 probability of maintaining in the acceptable classification during the 9-11-year window.

Non-high-density lipoprotein cholesterol classifications identified at age 9 years remained stable for over 2 years, supporting the appropriateness of screening at any point within the 9-11-year window. These findings offer insights into optimal lipid-screening practices, thereby enhancing early cardiovascular disease prevention.