Cholesterol Screening in Children and Family History of Coronary Heart Disease.
Background: Selective blood cholesterol screening of children based upon National Cholesterol Education Program (NCEP) guidelines of family history of premature cardiovascular disease (CVD) or parental hypercholesterolemia is inadequate in a population with high prevalence of coronary heart disease (CHD), low levels of cholesterol screening, low socio-economic status (SES) and diminished access to preventive health care. We hypothesize that universal cholesterol screening of pre-pubertal school children may be effective in identifying children and their parents with abnormal lipid levels in this high risk rural population. Fifth grade school children from seven rural Appalachian counties participated in a school based cholesterol screening program. Data on family history of premature CHD, anthropometric and blood pressure measurements, tobacco smoke exposure, dietary history and physical activity levels were collected at the time of screening. Seven hundred and nine 5 th grade students ( mean age 10.8 years) participated in the program. One hundred seventy four (24.5%) were considered presumptively dyslipidemic after non-fasting finger- stick (FS) cholesterol screening. Thirty six percent of these dyslipidemic children had a fasting lipid profile done. Dyslipidemia was confirmed in 37(59%) of these children. FS cholesterol levels were significantly correlated with fasting TC (r=0.80 p < 0.0001). Among confirmed dyslipidemic children, family history was not a good predictor of dyslipidemia (sensitivity 21.6%). Seventy nine parents of dyslipidemic children participated in fasting lipid profile assessment. Fifty two parents (67%) were dyslipidemic, most of them (79%) did not have a family history of premature CHD or hypercholesterolemia. FS cholesterol levels were also correlated with fasting TC of fathers (r=0.46 p=0.01), and mothers (r=0.32 p=0.02). Conclusion: Significant correlation exists between non-fasting FS cholesterol levels of children and subsequent fasting lipid profile of children and their parents. Family history has low sensitivity in predicting children with elevated serum cholesterol concentrations.