At what age is the first routine lipid testing recommended for pediatric patients?

First Routine Lipid Testing in Pediatric Patients

The first routine lipid screening for pediatric patients without cardiovascular risk factors should be performed once between the ages of 9 and 11 years, and again between the ages of 17 and 21 years. 1

Universal Screening Recommendations

• For children without cardiovascular risk factors or family history of early cardiovascular disease (CVD), lipid screening should be performed once between ages 9-11 years and again between ages 17-21 years 1
• Initial testing may be done with a nonfasting non-HDL cholesterol level with confirmatory testing with a fasting lipid panel if abnormal 1
• This universal screening approach is recommended by the American College of Cardiology/American Heart Association (ACC/AHA) and is concordant with the National Heart, Lung, and Blood Institute Expert Panel guidelines 1

Earlier Screening for High-Risk Children

• In children with a family history of early CVD (defined as MI, documented angina, or atherosclerosis in parents, siblings, grandparents, aunts, or uncles at <55 years for men, <65 years for women) or significant hypercholesterolemia, lipid screening should be performed as early as age 2 years 1
• Children with obesity or other metabolic risk factors should have lipid screening to detect disorders associated with metabolic syndrome 1
• Children with type 1 diabetes should have initial lipid profile performed soon after diagnosis (once glycemia has improved) if age ≥2 years 1

Rationale for Age-Specific Screening

• Ages 9-11 years are recommended because:
  • This is before puberty when lipid levels are relatively stable 1
  • Total cholesterol and LDL-C levels decrease by 10-20% during puberty 1
  • Atherosclerotic changes begin to diverge between affected and unaffected children around age 10 years 1
• Ages 17-21 years are recommended as the second screening point after puberty-related changes have stabilized 1

Follow-up Recommendations

• If initial LDL cholesterol is ≤100 mg/dL (2.6 mmol/L), subsequent testing should be performed at 9-11 years of age 1
• If LDL cholesterol values are within accepted risk levels (<100 mg/dL), repeating the lipid profile every 3 years is reasonable 1
• For abnormal results, follow-up should include lifestyle counseling and potential referral to a specialist for severe abnormalities 1

Current Screening Practices

• Despite recommendations, lipid screening remains underutilized in pediatric practice, with only about 9-11% of children aged 9-11 years receiving recommended screening 2
• Among those screened, approximately 30% have abnormal lipid levels, with higher prevalence in children with obesity 2
• Selective screening based only on family history or risk factors misses many children with lipid abnormalities 1, 3

Clinical Implications

• Universal screening helps identify children with genetic dyslipidemias who may not have obvious risk factors 3
• Early identification allows for reverse-cascade screening of family members to detect familial forms of hypercholesterolemia 1
• Nonfasting lipid parameters are similar to fasting ones, making screening more practical in clinical settings 1
• The goal is early identification and intervention to reduce long-term cardiovascular risk 1