Overview of follow-up of children undergoing lipid screening

HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; CVD: cardiovascular disease; FH: familial hypercholesterolemia; SLE: systemic lupus erythematosus; JIA: juvenile idiopathic arthritis; CoA: coarctation of the aorta; AS: aortic stenosis; TGA: transposition of the great arteries; HCM: hypertrophic cardiomyopathy.
* For children with underlying risk factors for premature CVD (listed below)^Δ, lipid screening begins at the time the risk factor is first identified (generally not earlier than age 2 years) with subsequent testing every 1 to 3 years depending on the nature of the risk factor(s). For children without underlying risk factors for premature CVD, routine lipid screening is performed twice during childhood: once before puberty (age 9 to 11 years) and once after puberty (age 17 to 21 years). Refer to UpToDate topic on dyslipidemia screening in children for additional details.
¶ Lifestyle modifications may include low saturated fat diet; increased intake of dietary fiber through fruits, vegetables, and whole grains; supplementation with plant stanols and sterols; increasing physical activity; and, in obese children, weight loss. Refer to the UpToDate topic on management of dyslipidemia in children for further details of nonpharmacologic management of hypercholesterolemia.
Δ Risk factors for premature CVD in children are similar to those in adults and include hypertension, diabetes, obesity, smoking/smoke exposure, and family history of premature atherosclerotic CVD. In addition, other medical conditions that can present during childhood and that are associated with increased risk of early CVD include: chronic kidney disease, Kawasaki disease (with current or regressed coronary artery disease), childhood cancer, transplant vasculopathy, chronic inflammatory diseases (eg, SLE and systemic JIA), HIV, certain congenital heart disease defects (CoA, AS, TGA, congenital coronary artery anomalies), cardiomyopathy (eg, HCM), pulmonary hypertension, and adolescent depressive and bipolar disorder.
◊ Confirmatory testing consists of 2 fasting lipid profiles obtained 2 weeks to 3 months apart (ie, if the patient had a fasting lipid profile performed as the initial screen, a second fasting lipid profile is obtained 2 weeks to 3 months later; if the patient's initial screen was performed using nonfasting non-HDL-C, 2 separate fasting lipid profiles should be performed). Average the 2 results.
§ For further details on the management of hypercholesterolemia and FH, refer to separate UpToDate topics on pediatric dyslipidemia and FH.
¥ Secondary causes of hypercholesterolemia include diabetes mellitus, nephrotic syndrome, hypothyroidism, pregnancy, hepatic disease, and certain medications (eg, glucocorticoids, antiretrovirals). Refer to the UpToDate topic on screening and diagnosis of dyslipidemia in children for further details.