What parents should know about the importance of early cholesterol screening

Healthy blood cholesterol levels are considered essential to heart health and are associated with lower risk of heart disease.

There are two types of cholesterol — LDL cholesterol, which is bad, and HDL, which is good. Too much of the bad kind or not enough of the good kind increases the risk that cholesterol will slowly build up in the inner walls of the arteries, such as those that feed the heart and brain.

High cholesterol often has no symptoms, so it’s important to have your health care professional check your cholesterol levels with a simple blood test. Cholesterol tests are a key part of routine health screenings for adults. But for young people, it's a different story.

Few children and teenagers are screened for cholesterol issues. Several factors, including varying recommendations from medical experts, might confuse parents and even their primary care physicians, cholesterol experts say. Whatever the cause, these missed opportunities could lead to overlooking a serious health risk.

About 1 in 5 adolescents in the U.S. has a cholesterol level that is out of a healthy range, said Dr. Sarah de Ferranti, a pediatric cardiologist at Boston Children’s Hospital. “So this is definitely an issue that affects children,” she said. “Fortunately, not all of those abnormalities are sustained over time, and not all need medication, and many can be addressed with following a healthy lifestyle. But definitely, kids are afflicted with abnormal cholesterol values.”

The 2018 American Heart Association and American College of Cardiology cholesterol guidelines(link opens in new window) support checking for abnormal cholesterol once between ages 9 and 11 and again once between ages 17 and 21. Earlier screenings, as early as age 2, are reasonable for those with a family history of early heart disease or very high cholesterol.

These guidelines are in line with recommendations from the National Heart, Lung, and Blood Institute(link opens in new window) and the American Academy of Pediatrics(link opens in new window). Yet testing rates in children and adolescents have been low. Estimates vary, but a study published in JAMA Network Open(link opens in new window) in 2024 found that only 11% of people ages 9 to 21 are screened.

Most people can keep their levels healthy by eating a nutritious diet that emphasizes foods that are low in saturated fat and high in fiber and by getting enough exercise. The American Heart Association recommends that kids ages 6 to 17 get at least an hour of moderate- to vigorous-intensity physical activity a day.

In addition to diet and exercise, genetics can affect cholesterol levels. The primary goal of testing children is to screen for that inherited issue, said Dr. Emily F. Gregory, an assistant professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania.

“It's looking to pick up a disease called familial hypercholesterolemia, which presents rarely but with extremely high levels of cholesterol starting at a very young age,” said Gregory, who is also an attending physician at the Children’s Hospital of Philadelphia. The inherited condition prevents the body from removing LDL cholesterol from the blood. People with untreated familial hypercholesterolemia have 20 times the risk of developing heart disease, with plaque buildup sometimes detected in the heart arteries as young as age 17.

Estimates vary, but de Ferranti said the most common form of familial hypercholesterolemia affects an estimated 1 in 250 people in the U.S.

But according to AHA statistics(link opens in new window), the condition is diagnosed in fewer than 10% of those who have it. Their first symptom of familial hypercholesterolemia, de Ferranti said, might be a heart attack in young adulthood.

“We want to prevent that,” she said. “And the only way to do that is to identify this lipid abnormality through screening and then to go ahead and treat, when necessary, both with lifestyle and oftentimes with medication.”

But several things get in the way of testing cholesterol in all children.

The U.S. Preventive Services Task Force(link opens in new window) considers current evidence “insufficient to assess the balance of benefits and harms of screening for lipid disorders” in people ages 20 or under without symptoms. Doctors, it said, “are encouraged to use their judgment when deciding whether to screen for lipid disorders in children and adolescents.”

Gregory said the task force’s lack of an endorsement for universal testing does not mean testing is considered harmful – just that the current evidence hasn’t met its high standard for making a recommendation.

Another barrier, de Ferranti said, is that pediatricians are busy. “When they see a patient in the office, they’ve got a long list of things that they need to sort through,” she said, and those problems might seem more urgent than screening for a rare illness.

So, what’s a parent to do?

“It’s important for parents to know that these recommendations are out there and to discuss them with their (child’s) physicians,” Gregory said. If your child is of the right age and is getting a blood test anyway, “I think there’s certainly a good argument to add on the cholesterol.”

Most of the time, an out-of-range reading doesn’t mean a child has inherited a cholesterol problem, Gregory said. The first line of treatment is thinking about lifestyle changes, including getting enough sleep.

De Ferranti added that “if you know that there is a family history of cholesterol or heart problems in your family on either side, you should bring that to the table” when you visit your child’s pediatrician.