Canadian Pediatricians Recommend Cholesterol Testing Starting At Age 2 ⋆ The Costa Rica News

In a statement released on February 27, the organization notes that atherosclerosis—the buildup of plaque, which includes cholesterol, in the arteries—begins in childhood and is a key factor in the development of heart disease and stroke.

The lead author of the document, pediatric cardiologist Dr. Michael Khoury, states that approximately one in every 300 Canadians has high cholesterol due to a genetic condition called familial hypercholesterolemia (FH).

Familial hypercholesterolemia is an inherited genetic disorder that causes extremely high levels of LDL (“bad”) cholesterol from birth, increasing the risk of heart attacks and heart disease at a young age.

According to Khoury, universal screening through blood tests would allow for early detection of the condition and the initiation of treatment, including changes in diet and physical activity.

Treating the condition in childhood can prevent cardiovascular disease in adulthood, says Khoury, a specialist in preventive cardiology at Stollery Children’s Hospital and the University of Alberta in Edmonton.

Without universal screening, doctors are missing about 95% of children with HF, since most do not have symptoms.

Dr. Alykhan Abdulla, a family physician in Manotick, Ontario, agrees that screening and preventive treatment are of great value.

“We need to move away from the model focused on treating the disease once people are already sick… we must act much earlier in the chain, in prevention,” he says.

However, the doctor expresses concern about the impact on healthcare system resources. Scheduling thousands of blood tests and ensuring proper follow-up would place additional strain on an already overburdened system.

“And if we detect three, four, or five thousand new cases of high cholesterol in young children, we’ll have to provide them with support for physical activity and nutritional counseling,” he warns. “That will require a lot of resources, but these are investments we should make.”

What causes familial hypercholesterolemia?

FH is usually caused by a mutation in the low-density lipoprotein (LDL) receptor in the liver. This mutation prevents LDL cholesterol from entering the liver, causing it to accumulate in the blood, explains Khoury.

In addition, the liver misinterprets this as a “low-cholesterol environment” and increases its production.

LDL cholesterol, along with fat and other substances, is a major component of the plaque that builds up in the arteries and restricts blood flow to the heart and brain.

If a child tests positive for FH, they are usually referred to a pediatric lipid specialist to monitor LDL levels and initiate treatment as needed.

Mike Heathcote, a resident of Edmonton, knew from a young age that he had high cholesterol, but it was later that doctors confirmed the genetic mutation associated with FH.

Aware that he could pass it on, he decided to have his two children tested, and both were found to have the condition.

“They led a healthy, active lifestyle, just like any other child. If you don’t get tested, you’d never know,” she says.

Detecting it early allowed her to start medication for her children.

“The hope is that, over time, it will be as if it had never been a problem. Their arteries will be fine, with no long-term damage,” she emphasizes.

His 15-year-old daughter, Haley Heathcote, is grateful that the condition was detected early.

“It’s as simple as a prick in the arm, and you could be saving your life,” she says, referring to the blood test.

The benefits of the medications outweigh the risks

Dr. Khoury explains that long-term safety data show that statins—commonly used in adults with high cholesterol—can be administered to children as young as eight, generally at lower doses.

“The benefits of using these medications far outweigh the risks,” he stated.

Studies that have followed children treated for 20 years show a significant reduction in cardiovascular risk in adulthood.

“If we treat these children properly, we can normalize their cardiovascular risk and eliminate the likelihood that they will suffer a heart attack or stroke early in the most productive stage of their lives,” he notes.

The recommendation to screen children between the ages of 2 and 10 is intended to give primary care physicians multiple opportunities to perform the test, although drug treatment would likely not begin until age 8. Generally, patients will need to continue taking medication for the rest of their lives.

The American Academy of Pediatrics currently recommends that all children undergo cholesterol screening between the ages of 9 and 11.

In the United States, pediatricians may suggest screening as early as age 2 if there are significant risk factors, such as high blood pressure, obesity, or diabetes, a known family history of HF, or close relatives with heart or cholesterol problems.

According to Khoury, until now, family physicians and pediatricians in Canada did not have clear recommendations on this matter.

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