Cholesterol screening in children and adolescents with a positive family history of cardiovascular disease or parental history of hypercholesterolemia was recommended by the Expert Panel on Blood Cholesterol Levels in Children and Adolescents in 1991. A serum total cholesterol concentration of 170-199 mg/dl is classified as 'borderline' and 200 mg/dl or greater as 'high', for males and females aged 2-19 years. The cutpoints, 170 and 200 mg/dl were thought to approximate the 75th and 95th percentiles of the Lipid Research Clinics Prevalence Study (North America) distribution for ages 0-19 years. However, total cholesterol concentration varies by age and sex in childhood and adolescence. This knowledge prompted analysis of recent data from Project HeartBeat!, a community-based longitudinal study in Texas, and from a national population sample survey, the Third National Health and Nutrition Examination Survey, to investigate the impact of this variation on projected screening results. Effects of age (from 8 to 17 years), sex, and race (black and non-black or white) were evaluated through linear regression techniques. The models demonstrate a marked decline in serum total cholesterol concentration with age following the pre-teen peak. Significant effects of sex are observed in both data sets and by race in one of them. The 75th and 95th percentile values range from 164 to 200 and 193 to 229 mg/dl, respectively, with the highest values at the earliest ages. Substantially greater proportions of children and adolescents than 25% or 5% would be screened positive at cutpoints of 170 or 200 mg/dl, especially at younger ages - but for older males smaller proportions would be positive. Considering the merits of variable vs. fixed screening criteria for total cholesterol concentration, we conclude that age- and sex-specific criteria are preferable for selective screening.
- Cholesterol concentration
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Cardiology and Cardiovascular Medicine