Of all the things parents worry about when it comes to their children's health, high cholesterol probably isn't very high on the list.
But roughly 1 in 3 primary school kids may already have borderline-high or high cholesterol, according to a large study to be presented this week at a meeting of the American College of Cardiology. And while the cholesterol may not be causing any evident problems for those children now, researchers say, it could already be starting to harden and narrow their arteries, paving the way for heart disease and stroke down the road.
In fact, previous research has suggested that a child's total cholesterol level is the single greatest predictor of whether he or she will have extremely high cholesterol as an adult, says Thomas Seery, a pediatric cardiologist at the Texas Children's Hospital and the study's lead author.
Seery's study is one of the largest to glean cholesterol data from the routine physical exams of a broad cross-section of healthy children. The findings, Seery says, offer further support for the guidelines the National Heart, Lung and Blood Institute issued in 2011, calling for cholesterol screening for all children between ages 9 and 11, and again between ages 17 and 21. For most kids, making changes in diet and getting more exercise is all that's needed to nudge cholesterol levels in a healthy direction, Seery says.
"Previously we screened based on risk factors alone," he says. "And studies have shown that when screening in such a fashion, it's estimated that we miss between 30 and 60 percent of kids who have high cholesterol levels."
In this study, Seery and his colleagues searched the medical records of more than 12,700 children ages 9 to 11 who got cholesterol screenings as part of a routine physical. The scientists were especially interested in the levels of HDL ("good" cholesterol), LDL ("bad" cholesterol), and the amount of triglycerides in the blood.
A little more than 4,700 kids — or about 37 percent of the sample — had borderline or high cholesterol (defined as 200 mg/dl or higher). Among children with worrisome indicators, boys were more likely than girls to have high total cholesterol, and high levels of LDL cholesterol — the sort found to increase risk of a heart attack or stroke in adulthood. Girls with worrisome markers, on the other hand, were more likely to have low levels of HDL cholesterol — the type that helps protect against heart disease by moving cholesterol away from the arteries. The researchers also found that Hispanic children were more likely than other kids to have high levels of triglycerides and low levels of HDL cholesterol.
"If we can fix this problem earlier," Seery says, "and work toward reducing those levels of cholesterol — therefore reducing lifetime exposure to high cholesterol — we can work toward reducing the incidence of cardiovascular disease as an adult."
Not all doctors are convinced that universal screening does more good than harm. Some clinicians believe that aggressive screening to detect a disease early on leads more kids to be on medication that they don't need.
But "no one's recommending that [all these] kids be put on anti-cholesterol medicine," Seery tells Shots. "In fact, we believe that only 1 to 2 percent of kids with high cholesterol would qualify for cholesterol-lowering medication," he says — primarily children who have extremely high levels of cholesterol because of a genetic disorder.
For most children, Seery says, the prescription instead is for the whole family to get "hooked" on a better diet and exercise routine. "We know that diet and regular exercise work."