[Hypercholesterolemia in children and young adults: should screening be done?]

Risk factors such as hypercholesterolemia, hypertension and smoking are already operative in children and during adolescence; it has been demonstrated that they favour the development of early atherosclerosis lesions in young adults. This fact poses the question of diagnosis and treatment of risk factors. There is still controversy whether hypercholesterolemia should be searched for by universal or by selective screening, or by no screening at all. Several professional organizations favour a selective screening strategy, i.e. determination of serum cholesterol if one parent has premature coronary heart disease (before age 55 yr) or if the family has familial hyperlipidemia, in particular familial hypercholesterolemia. This strategy is advocated here: cholesterol should be measured early, i.e. between age 6 and 8 yr. A total serum cholesterol of > 5.2 mmol/l is elevated (approx. 75th percentile) and should be further evaluated and possibly treated. The presence of familial hypercholesterolemia should be looked for in particular: such individuals can now be diagnosed with molecular genetic tools, and they are particularly prone to develop premature coronary heart disease. Treatment of hypercholesterolemia is mainly of a dietary nature, or possible with a bile acid binding resin (cholestyramine). Other drugs have not been sufficiently evaluated for efficacy and safety; they may be indicated in special cases such as patients with a very high risk. Young people with familial hypercholesterolemia should be particularly counselled to avoid other risk factors such as smoking.