Cholesterol: All in the family?

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istock_000009535958largeBlood tests during immunizations can detect high cholesterol risks in children, parents

Routine immunization visits can help prevent diseases before they strike. Now, a study from the New England Journal of Medicine shows that an additional heel stick during these appointments can identify genetic markers for high cholesterol – a step that might help reduce or even prevent the risk of future heart disease in both children and parents.

The study examined over 10,000 one- and two-year olds who had an additional blood test during a regularly scheduled immunization visit. The extra test scanned for genetic markers that identify the risk of high cholesterol later in life. When a marker was found, a second test showed which parent had the same marker. For every 1,000 screenings, four children and their corresponding parent were found to have the same marker.

“That means that eight individuals with familial high cholesterol were identified for every 1,000 kids screened – people who otherwise might not have known they were at risk for high cholesterol,” said Stuart Rowe, MD. Rowe is a pediatric cardiologist at Dell Children’s Medical Center of Central Texas, part of Ascension, the largest nonprofit health system in the U.S. and the world’s largest Catholic health system.

Heart disease is the number one killer in America, according to the CDC, and high cholesterol is a known risk factor. The study also showed that family-related cholesterol is much more common than previously thought. “The study suggests its prevalence is one in every 274 people,” said Rowe. “That’s almost twice as high as the frequently quoted number of one in 500.”

Not just “adults-only”

High cholesterol isn’t reserved for adults. According to Rowe, it can be passed down to a child by one or both parents, and can also be caused at an early age by childhood obesity, poor diet or diabetes — all of which are heart disease risk factors.

“For kids who inherit high cholesterol from their family, diet and other lifestyle changes may only make a small difference. They may need a statin or other drug therapy – usually when they hit adolescence,” said Rowe.

The importance of early detection

Early detection can improve treatment options for many health conditions. Current guidelines established by the National Heart Lung and Blood Institute and endorsed by the American Academy of Pediatrics call for a blood test measuring total cholesterol, LDL (“bad”) cholesterol, HDL (“good”) cholesterol and triglycerides to screen children as part of regular check-ups, once between the ages of nine and 11, and again between the ages of 17 and 21.

Children who have strong family history of high cholesterol or heart disease, are overweight or obese, have high blood pressure, are diabetic, or smoke should be evaluated by a doctor and screened as needed between the ages of 2 and 21, according to the guidelines.

The potential to screen children for a shared genetic marker as early as one or two years old allows both doctors and parents to be aware of the health risks linked to high cholesterol, and provides doctors with better chances to treat and prevent future problems. It also signals for parents to seek help to address their own heart disease risks, if they haven’t already done so.

The presence of the genetic marker doesn’t necessarily mean a future with high cholesterol, nor does its absence guarantee cholesterol won’t be a concern down the road. However, in some cases where the genetic maker is present, complications related to high cholesterol can begin at an early age.

“More studies have to be done to determine if defining the presence and type of familial high cholesterol mutation is cost-effective and clinically beneficial,” said Rowe.

Genes are not the only player

Regardless of a child’s genetic risk for high cholesterol, lifestyle and diet still matter. In many cases, high cholesterol can be lowered without medication. Try some of these family-friendly tips:

  • Take the family outdoors for walking, hiking, biking or swimming.
  • Use a gym or club membership to enjoy aerobic or spin classes together.
  • Involve your kids in meal planning and prep.
  • Plan colorful or themed meals including baked or grilled foods, whole grains, fruits and veggies.

Parents concerned about their child’s risk of high cholesterol should talk to their doctor about family history and other risk factors to decide the best screening and treatment options.