Cholesterol Screening or Testing

What is cholesterol?

Everyone needs to have some cholesterol in their blood. Cholesterol is the normal way fat is carried in the bloodstream. Cholesterol is a fat that is essential for building hormones and cells. High-density lipoproteins (HDL) and low-density lipoproteins (LDL) transport cholesterol to the blood. The HDL and the LDL together are called "total cholesterol." HDL is called the "good" cholesterol because it carries cholesterol away from the arteries to the liver. The liver helps the body get rid of cholesterol. The LDL is called "bad" cholesterol. If you have too much LDL, the LDL deposits cholesterol on the inner walls of the arteries. As a result your arteries become clogged.

Why is having low cholesterol important?

People who have higher-than-normal levels of cholesterol have a greater risk of developing clogging or narrowing of the blood vessels that carry blood to the heart muscle (coronary arteries). This narrowing is called coronary heart disease (CHD). If people lower their cholesterol levels, they reduce their chances of having heart disease. A 1% decrease in blood cholesterol leads to a 2% decrease in the risk of CHD in adults.

The amount of cholesterol and saturated fats we eat affect the level of cholesterol in our blood. If we eat less cholesterol and saturated fat, we will have less cholesterol in our blood.

Many children and teenagers who have high cholesterol continue to have high cholesterol when they are adults. Teenagers who reduce their cholesterol levels with proper diet and exercise may have a better chance of having low cholesterol when they are adults.

What are normal and abnormal cholesterol levels?

 
               Total            LDL            HDL
            Cholesterol     Cholesterol    Cholesterol

Normal         <170            <100           >60
Borderline    170-200         100-300        40-60
Abnormal       >200            >130           <40

Should children have their cholesterol checked?

The American Academy of Pediatrics and the American Heart Association agree that all children who are at high risk for coronary heart disease should be screened soon after they are 2 years old.

The normal diet of children younger than 2 years is high in fat and therefore high in cholesterol. It is not appropriate to test children younger than 2 years.

A child is at high risk of developing CHD as an adult if members of the family have had high blood cholesterol or early coronary heart disease. Family members include parents, siblings, grandparents, aunts, and uncles. A history of early coronary heart disease includes heart attack, angina (pain in the chest when part of the heart is not getting enough blood), stroke, or bypass surgery that occurs in men less than 50 years old or women less than 60 years old. The information about grandparents is important because other relatives might not yet be old enough to have developed heart disease. Over half of the children who have high cholesterol levels are found by testing children with these high risk factors.

Doctors do not always agree on when to check the cholesterol levels of children who are not high risk. The main reason for testing everyone is to identify all children with high cholesterol. Eating and exercise habits that lower cholesterol levels need to be started early in life. The main arguments against testing all children are that it is costly, high cholesterol levels do not persist into adulthood half the time, and healthy diets can be started for all children without knowing their cholesterol levels. If a doctor or clinic does check the cholesterol levels of all children, they usually check children between 2 and 5 years old, often when they start kindergarten.

How often should my child's cholesterol be checked?

If your child's cholesterol is borderline high or abnormal, it will be checked again 1 to 2 weeks after the first test. Cholesterol levels do vary somewhat day to day, so it is important to confirm that the cholesterol is high.

Children with confirmed high total cholesterol greater than 200 (95th percentile) will then have blood drawn for a lipid profile or panel. This test measures the levels of LDL, HDL, and triglycerides, as well as total cholesterol. Treatment will start and the level of cholesterol will be checked again in about 2 to 4 months.

If your child has a total cholesterol level that is borderline high between 170 and 199, treatment can start without the lipid panel. Your child's total cholesterol will probably be rechecked every year.

Children with normal total cholesterol below 170 (75th percentile) do not need their cholesterol checked again until they become adolescents. Most physicians check the total cholesterol level of adults every 5 years as long as it remains in the normal range.

Lipid panels are not done for all children because they cost much more than the total cholesterol test. In addition, the lipid panel requires blood drawn from a vein, a more difficult procedure than pricking a finger.

Should my whole family be checked?

If your child has abnormally high cholesterol (higher than 95th percentile), everyone in your family should have their total cholesterol checked. Very often the close relatives of children with high cholesterol also have high cholesterol. Discovering that other family members have high cholesterol will further encourage you to start your family on a healthier diet and exercise program.