DEFINITION AND APPLICATION OF THE DISCRETIONARY SCREENING INDICATORS ACCORDING TO THE NATIONAL CHOLESTEROL EDUCATION-PROGRAM FOR CHILDREN AND ADOLESCENTS

Objectives: (1) To propose definitions for the discretionary screening indicators described by the National Cholesterol Education Program fo r Children and Adolescents (NCEP-Peds); (2) to examine the relative pr evalence of major screening indicators (family history of premature he art disease and parental plasma cholesterol concentration greater than or equal to 6.21 mmol/L (240 mg/dl)) and discretionary screening indi cators (excessive consumption of fat or cholesterol or both, smoking, diabetes, hypertension, and steroid use) in a family population; and ( 3) to evaluate the relative value of the major and the discretionary i ndicators in detecting high serum levels of low-density lipoprotein-ch olesterol (LDL-C) (greater than or equal to 3.36 mmol/L (greater than or equal to 130 mg/dl)), Design: Control cohort from a case-control st udy, Setting: Lipid research clinic, Participants: White children and adolescents <20 years of age from 232 nuclear families who participate d in the Cincinnati Myocardial Infarction Hormone Study, Main outcome measures: (1) Number of children who have major and discretionary scre ening indicators; (2) sensitivity and specificity of the major and the discretionary screening indicators in identifying children with LDL-C concentrations >3.36 mmol/L (130 mg/dl) (high LDL-C), Results: With c utoff points of the 90th percentile for blood pressure, the 85th perce ntile for obesity, and the 80th percentile for dietary fat and cholest erol, and self-report for diabetes, smoking, and corticosteroid use, 5 4% of the 232 children in the cohort had one or more discretionary ind icators, Additionally, applying the major screening indicators raised the percentage of children identified to 74%, Twenty-eight percent had both major and discretionary indicators. Having a discretionary scree ning indicator did not increase the probability of having a major indi cator, Applying both discretionary and major screening indicators to t he cohort identified 96% of the children who had a high concentration of LDL-C; 30% of the children with high LDL-C levels were discovered s olely by the discretionary indicators. Similar sensitivity and specifi city were noted between the major and the discretionary indicators. Ch ildren with high LDL-C concentrations were more likely to have multipl e screening indicators. Conclusion: Discretionary and major screening indicators suggested by the National Cholesterol Education Program for Children and Adolescents identify different subsets of children at ri sk of having premature cardiovascular disease. Both major and discreti onary indicators contribute to the identification of children with hig h LDL-C concentrations.