Level 3: Lacking direct evidence
The American Academy of Pediatrics has released a clinical report on lipid screening and cardiovascular health in childhood (Pediatrics. 2008;122:198-208), which replaces the 1998 policy statement on cholesterol in childhood. Recommendations include (1) increased physical activity and dietary changes for children who are at risk of overweight or obesity and (2) screening with a fasting lipid profile between ages 2 and 10 years in children with a family history of dyslipidemia or premature cardiovascular disease of dyslipidemia. Screening is also recommended if the family history is unknown or in the presence of other cardiovascular disease risk factors. Consider pharmacologic interventions in patients older than 8 years with LDL >190 mg/dL (4.9 mmol/L), >160 mg/dL (4.1 mmol/L) with family history of early heart disease or two or more additional risk factors, or >130 mg/dL (3.4 mmol/L) in children with diabetes mellitus. As the authors note, there is a lack of data to support specific evidence-based recommendations for cholesterol screening or implementing pharmacologic treatment in children.