Because risk factors for cardiovascular disease and evidence of atherosclerosis can be evident in childhood, early identification of high-risk children may result in effective preventive interventions. The American Academy of Pediatrics (AAP) recommends cholesterol screening in children and adolescents, with additional management recommendations for those with hypercholesterolemia. Screening recommendations are in part based on family history. However, it is not clear that using family history to screen for cardiovascular disease is useful in children. In this population-based study, O’Loughlin and associates evaluated the usefulness of the AAP guidelines to determine whether screening based on family history would be better at identifying children with high low-density lipoprotein (LDL) cholesterol than screening the whole population.
Groups of 25 children were sampled randomly from 189 schools in Quebec. Patient and parent questionnaires, anthropometric measures, and lipid panels were used as sources of information in 2,217 subjects. Parents also were surveyed on history of hypercholesterolemia and cardiac risk factors and disease.
About one fourth of the parents had a history of hypercholesterolemia and/or cardiovascular disease, 18.3 percent had borderline/high LDL cholesterol, and 4.8 percent had high LDL cholesterol. Sensitivity and specificity for high LDL cholesterol were 50.6 percent and 69.1 percent, respectively, and the positive predictive value was only 7.7 percent. The prevalence of high LDL cholesterol in the population studied was 2.9 percent higher than the true population prevalence, suggesting that a parent history performs only marginally better than general screening in identifying at-risk youths. The population prevalence for identifying youths with borderline/high LDL cholesterol was 23.7 percent, compared with an overall prevalence of 18.3 percent. Subgroup analysis according to income, family origin, and other parental risk factors such as diabetes did not improve outcomes.
The authors conclude that parental history is not a useful screening prompt for identifying hypercholesterolemia in children and adolescents, a finding consistent with previous studies. The authors state that this finding is likely because of the poor accuracy of parental self-report. According to the authors, most adults are unaware of their cholesterol levels.