Screening for Lipid Disorders in Children and Adolescents: Recommendation Statement.

Dyslipidemia, a genetic or multifactorial disorder of lipoprotein metabolism, is defined by elevations in levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non–high-density lipoprotein cholesterol (non–HDL-C), triglycerides, or some combination thereof, as well as lower levels of HDL cholesterol (HDL-C). Elevations in levels of TC, LDL-C, and non–HDL-C are associated with risk of cardiovascular disease in adults, as are lower levels of HDL-C and, to a lesser extent, elevated triglyceride levels. Heterozygous familial hypercholesterolemia occurs in approximately 1 of every 200 to 500 persons in North America and Europe and is more prevalent among populations with known founder effects (up to 1 of 100 persons).1-3 Familial hypercholesterolemia is variably defined in the literature but generally includes highly elevated LDL-C levels (e.g., ≥ 190 mg/dL), genetic mutation, or both. Alternatively, dyslipidemia can be a multifactorial disorder, with both polygenic and environmental causes, including obesity. Multifactorial dyslipidemia is defined by elevations in levels of LDL-C (≥ 130 mg/ dL [to convert LDL-C values to mmol/L, multiply by 0.0259]), TC (≥ 200 mg/dL [to convert TC values to mmol/L, multiply by 0.0259]), or both that are not attributable to familial hypercholesterolemia.4-6 Obesity is associated with slight elevations in LDL-C; it is more strongly related to elevated triglycerides and lower HDL-C. Recent estimates from the National Health and Nutrition Examination Survey (NHANES) indicate that 7.8% of children aged 8 to 17 years have elevated levels of TC (≥ 200 mg/dL), and 7.4% of adolescents aged 12 to 19 years have elevated LDL-C (≥ 130 mg/dL).1,4,5 The rationale for screening for lipid disorders in children and adolescents is that early identification and treatment of elevated levels of LDL-C could delay the atherosclerotic process and thereby reduce the incidence of premature ischemic cardiovascular events in adults.