[Screening in the school milieu, at 4 years old, for hypercholesterolemia]

Area of Science:

• Pediatric lipidology
• Cardiovascular disease prevention
• Genetic epidemiology

Context:

• Atherogenic dyslipidemia and early-onset clinical atheroma in family members indicate a heightened risk for inherited lipid disorders.
• Early detection of hypercholesterolemia in children is crucial for timely intervention and secondary prevention of cardiovascular disease.
• Established lipid profiles and advanced lipoprotein analysis methods were employed to comprehensively assess lipid status.

Purpose:

• To screen four-year-old schoolchildren with a positive family history of premature cardiovascular disease for hypercholesterolemia.
• To investigate the prevalence of various lipid abnormalities, including hypercholesterolemia and elevated lipoprotein(a) [Lp(a)], in this high-risk pediatric cohort.
• To evaluate the clinical utility of determining Lp(a) levels in children with a family history of cardiovascular risk factors.

Summary:

• A study screened 3,565 four-year-olds, identifying 525 (16.2%) with a relevant family history. Of 72 children investigated, 8 had type IIA hypercholesterolemia, 8 had other lipid disorders, and 14 (20.6%) exhibited elevated Lp(a) levels.
• Elevated Lp(a) was observed either in isolation or alongside other atherogenic dyslipidemias.
• The findings underscore the significance of Lp(a) as an independent cardiovascular risk factor, even in the absence of elevated total cholesterol.

Impact:

• Recommends the routine determination of lipoprotein(a) [Lp(a)] levels in high-risk children due to its independent association with cardiovascular risk.
• Highlights the importance of early screening and lipid profiling in pediatric populations with a family history of premature cardiovascular disease.
• Contributes to the understanding of inherited lipid disorders and informs strategies for cardiovascular disease prevention in young individuals.