Universal Cholesterol Screening Referral Guidelines

What is New

New NHLBI/AAP guidelines strongly recommend universal cholesterol screening between the ages of 9 and 11 and again between 17 and 21 years of age.

What Has Not Changed

Selective screening with a fasting lipid profile (FLP) for children over 2 yr of age with a positive history of lipid and cholesterol disorders and/or premature heart disease in close family members has been recommended by the National Health, Lung, & Blood Institute (NHLBI), endorsed by the American Academy of Pediatrics (AAP) since 1992. Since 2008, selective screening FLP was expanded to include children with conditions that increase risk of cardiovascular disease with or without a family history.

Rationale for Universal Screening

The new expanded guidelines are based on research showing:

Early atherosclerosis exists in young patients with elevated cholesterol
Early treatment of cardiovascular risk factors in youth is effective
Lipid disorders are common in children and increasing coincident with childhood obesity
Approximately 30-60 percent of children with dyslipidemias are missed using the traditional selective screening methods.

Universal screening is designed to identify lipoprotein and cholesterol disorders in any child who might benefit from early cardiovascular risk reduction interventions- typically therapeutic lifestyle change with an emphasis on heart-healthy nutrition and activity. Only an estimated 1 to 2 percent of children identified with positive risk factors may be recommended for adjunct medication.

One Significant Change in Screening Methods

The universal screening lipid profile for children (9-11 yr) and adolescents (17- 21 yr) can be done non-fasting. This is because it is now recognized that the level of cholesterol in the NON-high density lipoprotein cholesterol fraction (known as non-HDL-C) has comparable predictive risk to the low density lipoprotein cholesterol (LDL-C) calculation on a standard FLP. The non-HDL-C is often reported on lab results but can also be calculated from a standard lipid profile as total cholesterol minus HDL-C.