Our approach to lipid screening in children and adolescents

CVD: cardiovascular disease; CoA: coarctation of the aorta; AS: aortic stenosis; TGA: transposition of the great arteries; HCM: hypertrophic cardiomyopathy; SLE: systemic lupus erythematosus; JIA: juvenile idiopathic arthritis; HDL-C: high-density lipoprotein cholesterol; TC: total cholesterol; LDL-C: low-density lipoprotein cholesterol.

* Initial screening can be performed with a fasting or nonfasting lipid profile (with the latter, non-HDL-C is calculated based on the directly measured TC and HDL-C levels). Confirmatory testing with a fasting lipid profile should be performed if adverse levels are noted on initial screen (ie, TC ≥200 mg/dL, HDL-C <40 mg/dL, LDL-C ≥130 mg/dL, or non-HDL ≥145 mg/dL). For additional details, refer to the UpToDate topic on screening and diagnosis of dyslipidemia in children.

¶ These are general suggestions for the timing and interval of screening; they should be tailored to the child's specific risk profile. For example, for a child with a single traditional risk factor (eg, nonsevere obesity or smoke exposure without any additional risk factors), it is reasonable to begin screening later and repeat it less frequently. By contrast, for a child with other conditions with increased risk for CVD (eg, Kawasaki disease with known coronary artery aneurysm), it is reasonable to perform lipid screening earlier and more frequently.

Δ Family history of premature CVD is generally defined as heart attack, treated angina, interventions for coronary artery disease, sudden cardiac death, or ischemic stroke in a male parent or sibling before 55 years of age or a female parent or sibling before 65 years of age.