School-based universal screening for hypercholesterolemia in children

Abstract

Background: In 2011, the American Academy of Pediatrics recommended universal lipid screening during childhood and adolescence. However, this approach was shown to be lacking in adherence. Only 6% of non-high-risk children received lipid screening by age 12. Our study designed a school-based universal screening for hypercholesterolemia in children. The goal was to investigate a feasible strategy for lipid screening of children.

Methods: The study enrolled all the fourth-grade students of 30 elementary schools from 2020 to 2021. Non-fasting non-HDL was used as a screening tool. These students were classified into three groups: acceptable group (non-HDL < 120 mg/dL), borderline group (120-144 mg/dL), and abnormal group (≥145 mg/dL). The abnormal group was referred to our hospital for confirmatory fasting lipid studies. The complete rate and timing were calculated.

Results: Six hundred students were enrolled in this study. In the abnormal group (95 children), a total of 92 students received confirmatory fasting lipid studies. These confirmatory studies were completed within three months after the family received their reports. The study had a rate of coverage of 62% and the referred percentage of the abnormal group was 97%. BMI had poor association with fasting LDL (CORR = 0.06752, p = 0.444). In the abnormal group, only 29.5% children had family history of early CVD or dyslipidemia.

Conclusion: School-based universal screening for hypercholesterolemia in children is a feasible and effective way to identify patients at high-risk for early CVD. Neither BMI nor family history was a good indicator for the screening of dyslipidemia.

Keywords: Children; Hypercholesterolemia; Screening.