SCREENING FOR HYPERLIPIDEMIA IN CHILDHOOD - RECOMMENDATIONS OF THE BRITISH-HYPERLIPIDEMIA-ASSOCIATION

Children with familial hypercholesterolaemia are at high risk of devel oping coronary artery disease in early adulthood. The diagnosis should therefore be made in childhood. Population screening identifies a sma ll number of children with major genetically determined disorders of l ipid metabolism and a large number with polygenic hypercholesterolaemi a of uncertain prognostic significance. Selective screening based on a family history of familial hypercholesterolaemia or premature coronar y artery disease is an appropriate strategy for identifying most child ren with familiar hypercholesterolaemia. A non-fasting total cholester ol measurement is a suitable screening test: if the concentration exce eds 5.5 mmol/l, a fasting measurement of total cholesterol, high-densi ty lipoprotein cholesterol and triglyceride is required. The diagnosis in a child under 16 years should be based on finding a total choleste rol concentration greater than 6.7 mmol/l and a low-density lipoprotei n cholesterol concentration above 4.0 mmol/l on at least two measureme nts taken more than one month apart. Children should not usually be sc reened before the age of two years, but the aim should be to diagnose heterozygous familial hypercholesterolaemia before the age of 10 years . Affected children should be referred for specialist care.