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Cholesterol screening and family history of vascular disease
E D Primrose1, J M Savage, C A Boreham
1Department of Child Health, Institute of Clinical Science, Royal Victoria Hospital, Belfast.
Insights
Screening children for high cholesterol using family history alone is ineffective. Universal screening for hypercholesterolaemia in children may require further evaluation despite the importance of diet.
Area of Science:
- Pediatrics
- Cardiology
- Public Health
Background:
- Hypercholesterolaemia is a significant risk factor for coronary heart disease (CHD).
- Early detection and management of high cholesterol can slow atherosclerosis.
- Genetic predisposition suggests family history screening for vascular disease.
Purpose of the Study:
- To evaluate the effectiveness of family history in identifying hypercholesterolaemia in children.
- To assess the utility of family history-based screening for pediatric hypercholesterolaemia.
Main Methods:
- Serum total cholesterol was measured in 1012 children (aged 12-15).
- Family history of vascular disease was collected via questionnaire.
- Children were categorized based on cholesterol levels (< 5.2 mmol/l vs. >= 5.2 mmol/l).
Main Results:
- A family history identified only 33.2% of children with hypercholesterolaemia (sensitivity).
- The specificity of family history for detecting high cholesterol was 71.5%.
- Screening based solely on family history proved ineffective for identifying pediatric hypercholesterolaemia.
Conclusions:
- Family history screening alone is insufficient for detecting hypercholesterolaemia in children.
- Primary prevention through healthy diets is crucial for all children.
- The need for universal screening for pediatric hypercholesterolaemia warrants further investigation.
Abstract:
Hypercholesterolaemia is a major risk factor for the development of coronary heart disease (CHD). Early detection and management of hypercholesterolaemia could retard the atherosclerotic process. Given that CHD and hypercholesterolaemia cluster within families, a screening strategy based on a family history of vascular disease has been advocated. Serum total cholesterol concentrations were measured in a random stratified sample of 1012 children aged from 12-15 years old participating in a coronary risk factor surveillance study in Northern Ireland. Information about vascular disease in close family members was obtained by means of a questionnaire. The study population was divided into two groups according to total cholesterol values: (i) normal, < 5.2 mmol/l (n = 822) and (ii) raised, > or = 5.2 mmol/l (n = 190). A family history identified 63 out of 190 individuals with hypercholesterolaemia yielding a sensitivity of 33.2% and specificity of 71.5%. Our data indicated that a strategy whereby only children from high risk families are screened for hypercholesterolaemia is ineffective. While primary prevention emphasising a healthy diet for all is essential, the role of universal screening deserves further appraisal.