The Canadian Paediatric Society has suggested that cholesterol screening should be conducted for all children aged between two and 10 years. In a recent statement, the society highlighted that atherosclerosis, the accumulation of plaque in the arteries that includes cholesterol, begins in childhood and is a major contributor to heart disease and stroke.
Dr. Michael Khoury, a pediatric cardiologist and the lead author of the statement, pointed out that approximately one in 300 Canadians have elevated cholesterol due to a genetic condition known as familial hypercholesterolemia (FH). He emphasized the importance of universal screening through blood tests to detect FH early and initiate interventions such as dietary modifications and increased physical activity.
Dr. Khoury, who specializes in preventive cardiology at the Stollery Children’s Hospital and the University of Alberta in Edmonton, noted that early intervention in childhood can prevent the onset of cardiovascular diseases later in life. He highlighted that without universal screening, a significant portion of children with FH, around 95%, go undiagnosed as they typically do not exhibit symptoms.
Echoing the importance of screening and preventive care, Dr. Alykhan Abdulla, a family physician in Manotick, Ontario, emphasized the shift towards proactive healthcare to address underlying health risks. However, he expressed concerns about the potential strain on resources that widespread screening would pose, including the need for follow-up care and interventions if high cholesterol is detected in children.
Familial hypercholesterolemia (FH) is commonly caused by a mutation in the liver’s low-density lipoprotein cholesterol (LDL) receptor. This mutation hinders the liver from processing LDL cholesterol, leading to its accumulation in the bloodstream. The condition also triggers the liver to increase cholesterol production, contributing to the development of arterial plaque that restricts blood flow to the heart and brain.
Individuals testing positive for FH are typically referred to pediatric lipid specialists for ongoing monitoring and treatment based on their LDL cholesterol levels. Early detection of FH can enable timely interventions, as exemplified by Edmonton resident Mike Heathcote, who discovered his genetic predisposition to FH and subsequently had his children tested and started on medication to manage the condition.
Dr. Khoury highlighted that long-term data supports the use of statin medications, commonly prescribed for high cholesterol in adults, in children aged eight and above, emphasizing that the benefits outweigh the risks. Research has shown that early medication can mitigate cardiovascular risks in children with FH, reducing the likelihood of heart-related complications in adulthood.
The revised cholesterol screening guidelines proposed by the Canadian Paediatric Society aim to provide primary care physicians with opportunities to conduct blood tests for children between two and 10 years, with medication initiation typically around age eight and potentially continuing throughout life. While the American Academy of Pediatrics recommends cholesterol testing for children between nine and 11 years old, Canadian healthcare providers lacked clear screening guidelines until the recent recommendation by Dr. Khoury and the Canadian Paediatric Society.
