2025 – PAGE 142 – 143 – CARDIOLOGY

CHOLESTEROL SCREENING = HYPERLIPIDEMIA SCREENING

Risk factors for hyperlipidemia include anorexia, anticonvulsants, a sedentary lifestyle, steroid use, and CIGARETTES (biggest risk factor).

• Universal screening: recommended once from 9–11 years and again from 17–21 years using non-fasting non-HDL-cholesterol levels.
• Targeted screening is recommended at any age above 2 years when high-risk factors are found, including
  • Obesity: defined as BMI ≥ 95^th percentile if 2-20 years of age. Note that a child is considered overweight when the BMI is ≥ 85^th percentile and <95^th in this same age group.
  • Diabetes mellitus
  • Hypertension
  • Smokes or is under 12 years old and exposed to passive smoke
  • Family history: First- or second-degree relative with early coronary heart disease (<55 years in males, <65 in females) or parent with total cholesterol > 240 mg/dL or a known dyslipidemia

The recommended test for targeted screening is the fasting lipid profile, done twice separated by 2 weeks to 3 months.

If the LDL level is > 110, try diet and exercise alone. If the level is > 160, try diet modifications and then escalate to medications if there is no improvement within 6 months.

For the exam, the above should be more than sufficient. Guidelines actually state that if the LDL is > 160 and the patient has two risk factors, or it is > 160 and there is a strong family history, or the LDL is > 190, you may immediately start cholesterol lowering medications. For the test, choosing lifestyle modifications for any child with an LDL < 190 is probably a safe choice.

FAMILIAL HYPERCHOLESTEROLEMIA

Familial hypercholesterolemia is an autosomal dominant disorder due to a deficiency in LDL receptors. It can result in xanthomas of the skin.