Doctors Spar Over Cholesterol Screening in Kids

"[We don't know] how many children would need to be treated to prevent one heart disease death," said Newman, who is a professor of epidemiology and biostatistics and pediatrics at the University of California, San Francisco. "The medications would have to be extraordinarily safe, and there haven't been big studies with large enough numbers of children for long enough to know."

Newman recommends cholesterol screening start at adulthood and obese children not be screened too early.

"Many of these kids have totally normal lipid levels and many with high lipid levels are not obese," he said. "You can tell if someone needs to lose weight without having to do any blood test and recommendations for diet and exercise really apply to everybody."

But the issue of whom to screen and when is far from straightforward, said one cardiologist who was involved with neither the original guidelines nor the rebuttal.

"It's a tough call; it's ... worthy of debate," said Dr. Stephen Cook, associate professor of pediatrics at the University of Rochester Medical Center in Rochester, N.Y. Cook also said there may be an argument for universal or near-universal screening to identify kids with familial hypercholesterolemia, a genetic trait resulting in high cholesterol levels unusually early in life.

Cholesterol-lowering drugs during childhood may be able to stave off heart disease in this group of children, the rebuttal authors noted.

SOURCES: Stephen Cook, M.D., associate professor of pediatrics, University of Rochester Medical Center, Rochester, N.Y.; Thomas Newman, M.D., professor of epidemiology and biostatistics and pediatrics, University of California, San Francisco; July 23, 2012, Associated Press; August 2012 Pediatrics

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Published: July 2012