Denver, CO - The American Academy of Pediatrics has issued a new clinical report on lipid screening and cardiovascular health in children [1], a report that has taken on new urgency given the epidemic of childhood obesity and the subsequent increased risks of type 2 diabetes mellitus, hypertension, and cardiovascular disease, say its authors.

According to coauthors Drs Stephen Daniels (University of Colorado School of Medicine, Denver) and Frank Greer (University of Wisconsin Medical School, Madison), along with the Committee on Nutrition, the report "reemphasizes the need for prevention of cardiovascular disease by following Dietary Guidelines for Americans and increasing physical activity and also includes a review of the pharmacologic agents and indications for treating dyslipidemia in children."

The new report is published in the July 1, 2008 issue of Pediatrics and replaces the 1998 policy statement, "Cholesterol in Childhood." New data, write the authors, emphasize the negative effects of the excess dietary intake of saturated fats, trans fats, and cholesterol, and the effects of carbohydrates, the obesity epidemic, the metabolic/insulin resistance syndrome, and the decreased level of physical activity and fitness on the risk of adult-onset cardiovascular disease. "In addition," write Daniels and colleagues, "more data are now available on the safety and efficiency of pharmacologic agents used to treat dyslipidemia. Most of these data were not available at the time of the previous statement."

The new report recommends a diet for all children older than 2 years that is based on the Dietary Guidelines for Americans, which is published by the Department of Health and Human Services and the Department of Agriculture. For children or adolescents at higher risk for cardiovascular disease or with elevated LDL-cholesterol levels, changes in diet based on nutritional counseling and other lifestyle modifications are also recommended. For overweight or obese pediatric patients with high triglyceride levels or low HDL-cholesterol levels, weight management is the primary treatment and includes improvement in diet with nutritional counseling and increased physical activity.

The writing committee also states that the current recommendation is to screen children and adolescents with a positive family history of dyslipidemia or premature cardiovascular disease. It is recommended that pediatric patients for whom family history is not known and those with other cardiovascular risk factors, such as being overweight, obesity, hypertension, smoking history, and diabetes mellitus, be screened with a fasting-lipid profile. Screening should take place after two years of age, but no later than 10 years of age.

For those with no risk factors, treatment with pharmacologic agents should be used if LDL-cholesterol levels are persistently higher than 190 mg/dL. The cutoff point for therapy is lowered to 160 mg/dL for those with other risk factors. Although the initial goal is to lower LDL cholesterol to levels <160 mg/dL, targets as low as 130 mg/dL or even 110 mg/dL "may be warranted when there is a strong family history of cardiovascular disease, especially with other risk factors, including obesity, diabetes, mellitus, the metabolic syndrome, and other higher-risk situations," suggest the writing the committee.