Lipid (Cholesterol) Screening
Heart disease is one of the leading causes of death in the United States. One of the factors that contributes to heart disease is high cholesterol levels, and we now know that genetics are a major factor in a person’s cholesterol level. We also have known for several decades that cholesterol deposits in arteries actually begins in childhood.
For many years, cholesterol screening was recommended in children at higher risk of high cholesterol, mostly related to family history. Since 2011, however, cholesterol screening has been recommended for all children, once between 9 and 11 years old and again once between 17-21 years old. The test does not have to be fasting for screening purposes.
Children 2-9 years and 12-16 years old are screened if there are risk factors. We evaluate risk factors at 2, 4, 6, and 8 years of age, and every year from 12-16, at yearly well-child visits.
Children are considered at risk if there is a family member (parent, sibling, grandparent, aunt, or uncle) with heart attack, stroke, or coronary artery disease requiring surgery at < 55 years old in males and < 65 years old in females, or a parent with total cholesterol > 240 or other lipid disorder. Children are also at risk if they are obese, smoke tobacco, or have diabetes or hypertension, or other high-risk condition.
Children at risk need to be fasting for their test; we send children to the lab for a fasting level.
When the new guidelines were released, we began ordering the lipid screening and sent patients to the lab; however, that was very inconvenient and many patients did not go to the lab to get the test. We started performing test in-house to improve our care.
The test is covered by most insurance plans as far as we can tell. However, patients with Blue Cross/Blue Shield of Georgia (Anthem) are not allowed to have the test in our office. They can only have it done at LabCorp. Patients with this insurance can either go to the lab, or pay for the test out-of-pocket and get it done in our office.
Normal values in children
| Normal | Borderline | Elevated | |
| Total cholesterol (TC) | < 169 | 170-199 | 200+ |
| HDL (“good”) cholesterol | > 45 | 40-45 | < 40 |
| LDL (“bad”) cholesterol | < 110 | 110-129 | 130+ |
| Triglycerides (0-9 years old) | < 75 | 75-99 | 100+ |
| Triglycerides (10-19 years old) | < 90 | 90-129 | 130+ |
If your child’s level is borderline or elevated, we will check a fasting level at the lab.
References
Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2017.