Children could have their cholesterol levels tested at about 15 months of age to prevent heart disease later in life, say doctors in a study published on bmj.com today.

High cholesterol which runs in families is known as familial hypercholesterolaemia. It affects about two in every 1000 people and causes very high levels of low density lipoprotein (LDL) or ‘bad cholesterol’ in the blood. It carries a high risk of death from coronary heart disease.

Treatment to lower cholesterol reduces the risk substantially, but there is uncertainty over what screening strategy is likely to be effective.

So researchers at Barts and the London Queen Mary’s School of Medicine and Dentistry analysed published studies on total and LDL cholesterol in people with and without familial hypercholesterolaemia to determine the efficacy of screening and the best age to do this.

They identified 13 studies involving 1,907 cases and 16,221 controls.

They found that screening was most effective if done in early childhood (1-9 years). Screening at this age detected 88% of affected individuals, while screening newborns and young adults was much less effective.

Based on these results, the authors suggest that children could be screened when they visit their general practice for routine vaccinations at about 15 months of age.

Once an affected child is identified, their parents would then also be screened, since, given the inheritance of this disorder, for every affected child there would be one affected parent. Treatment to lower cholesterol could then be initiated immediately in the affected parent and delayed in the child until adulthood.

A potential strength of screening at the time of childhood immunisation, they explain, is that it would take place at a time when parents are receptive to the possibility of preventing disease in their child and therefore may be receptive to a family based strategy to prevent the consequences of the same disease within the family as a whole.

The proposed strategy elegantly screens for familial hypercholesterolaemia in two generations simultaneously with the potential of preventing premature coronary heart disease in nearly everyone with the disorder.

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BMJ-British Medical Journal