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Year-to-year variability of cholesterol levels in a pediatric practice
I Benuck1, S S Gidding, M Donovan
1Department of Pediatrics, Children's Memorial Hospital, Chicago, Ill.
Insights
Spontaneous cholesterol level variability significantly impacts hypercholesterolemia screening in children. Year-to-year changes affect National Cholesterol Education Program (NCEP) classification stability, especially in younger age groups.
Area of Science:
- Pediatric Endocrinology
- Clinical Chemistry
- Public Health Screening
Background:
- Blood cholesterol levels exhibit spontaneous variability.
- The National Cholesterol Education Program (NCEP) provides guidelines for hypercholesterolemia screening.
- Understanding cholesterol variability is crucial for accurate pediatric screening.
Purpose of the Study:
- To assess the impact of spontaneous blood cholesterol variability on hypercholesterolemia screening in children.
- To evaluate the stability of NCEP guideline classifications over time in a pediatric population.
Main Methods:
- Retrospective chart review of 646 children aged 3 to 19 years in a private pediatric practice.
- Analysis of cholesterol measurements taken at a mean 19-month interval.
- Assessment of factors contributing to cholesterol variability, including age, pubertal status, and regression to the mean.
Main Results:
- Cholesterol levels varied significantly with age and pubertal status; prepubertal children aged 9-12 had the highest levels.
- Visit-to-visit consistency of NCEP classification was poorer in younger children (kappa values ranging from 0.21 to 0.44).
- Only 40% of children with initial high cholesterol (≥5.17 mmol/L) maintained high levels at follow-up, with an average decline of 0.34 mmol/L.
Conclusions:
- Year-to-year variability in total cholesterol levels significantly affects the stability of NCEP classification in children.
- The findings highlight challenges in consistently classifying children's cholesterol status due to natural fluctuations.
- Pediatric screening protocols may need to account for cholesterol variability for improved diagnostic accuracy.
Objectives:
To study the impact of the variability of blood cholesterol levels, which are known to vary spontaneously. The impact of this variability on screening for hypercholesterolemia according to National Cholesterol Education Program (NCEP) guidelines was reviewed in a private pediatric practice.
Design:
Retrospective chart review.
Setting:
Private pediatric practice.
Patients:
Children (N = 646) aged 3 to 19 years.
Intervention:
Cholesterol measurements at a mean interval of 19 months between visits.
Main Outcome Measures:
Year-to-year change in cholesterol levels according to NCEP guidelines, regression to the mean, age, pubertal status, body mass index, hematocrit, interval between measurements, and season of the year were assessed for their contribution to cholesterol level variability.
Results:
Cholesterol level varied significantly with both age (P < .001) and pubertal status (P < .01) with children aged 9 to 12 years; prepubertal children had the highest levels. Visit-to-visit consistency of NCEP classification was poorer for younger children than for older children (kappa = 0.21 for 3- to 6-year-olds, 0.39 for 6- to 10-year-olds, and 0.44 for those older than 10 years). Of children with initial total cholesterol levels of 5.17 mmol/L (200 mg/dL) or greater, only 40% continued to have high levels at follow-up. A child with an initial cholesterol value of 5.17 mmol/L (200 mg/dL) showed an average decline of 0.34 mmol/L (13 mg/dL) at follow-up by regression analysis.
Conclusion:
Year-to-year variability in total cholesterol level has a significant impact on the stability of NCEP classification.