This heart health worry is affecting children
Universal cholesterol screening in children has become an important tool in the diagnosis and treatment of elevated cholesterol, a typically adult condition that is affecting more and more children. Screening can prompt lifestyle changes that can help turn the problem around.
“The rationale for universal screening is that early atherosclerosis exists in young patients with elevated cholesterol,” said Roshann Hooshmand, MD, a pediatrician with Cape Cod Pediatrics. “While the burden of atherosclerosis and cardiovascular disease has been in adults, there has been a lot of research over the past 50-60 years that has brought us to the idea that these diseases begin early in life and progress throughout their lifespan.”
Previously, Dr. Hooshmand would select individuals to test that were at risk based on family history of cardiovascular disease. The guidelines for testing included a family history of cardiovascular disease, an adult who was diagnosed over the age of 55 with some sort of cardiac event or a family member with hypercholesterolemia and was on medication.
The newer recommendations came about because 30-60 percent of children with dyslipidemia, or an imbalance of lipids, such as cholesterol, were being missed by just asking family history, because not everybody knows their family history, she said.
When To Test
The American Academy of Pediatrics recommends universal cholesterol testing between the ages of 9 and 11 and again between 17 and 21 years of age.
Children in the following groups are to be tested after 2 years of age but no later than 10:
- Those whose parents or grandparents have had a heart attack or been diagnosed with blocked arteries, had a stroke or other diseases affecting the blood vessels before the age of 55 in men or earlier than age 65 in women.
- Those whose parents have elevated cholesterols of 240 mg/dL or higher.
- Those whose family background is not known or those who have associated characteristics of heart disease, including high blood pressure, diabetes, smoking or obesity.
Treatment for Elevated Levels
“In our office, we do a point-of-care test using a drop of blood from a fingerstick,” said Dr. Hooshmand. “We get the results right away and we can evaluate their total cholesterol, their good cholesterol (LDL) and bad cholesterol (HDL). If it’s positive or above what we like to see for cholesterol, the next step is a fasting blood test at the lab.”
If the lab results are high, Dr. Hooshmand and her staff meet with the child and parents to discuss some lifestyle changes such as lower fat diet and exercise.
“We will give them resources and handouts on how to choose foods that will support a better cholesterol profile such as foods higher in fiber, animal proteins that are lean, lists of ingredients to look for in whole foods as opposed to processed foods,” she said. “We also review activity levels we would like them to achieve such as good cardiovascular exercise 3-5 times a week.”
She encourages parents to work with the children to make changes in their diet as a family goal and try to plan activities such as bike rides, walks, playing sports, swimming, or any activity with movement.
When it comes to nutrition, Dr. Hooshmand likes to use the phrase, “fridge first.” Healthier foods in the refrigerator such as fruits and vegetables, yogurt, cottage cheese, cheese sticks are good foods to take and go, she said.
Families with children at risk for cholesterol imbalance are asked to return in four to six months for follow-up and repeat cholesterol levels to check on progress and any changes in their profile.
“I find for the most part, if they have borderline cholesterol panels, there is great improvement in those who increase their activity and adjust their diet,” said Dr. Hooshmand. “Just by removing some of the processed foods, eating more whole foods, incorporating more fruits and vegetables, you do notice a difference.”
Children whose numbers are still quite high, are referred to the Preventive Cardiology Clinic at Boston Children’s Hospital. “They have cardiology specialists and nutritionists to help them and will prescribe pharmaceutical treatment if necessary,” said Dr. Hooshmand.
“Early treatment for these risk factors is effective. And lipid disorders, especially common in kids with obesity, have become one of the biggest healthcare crises in children we have in this country,” she said.
