Canadian pediatricians recommend cholesterol testing for children under 2 to catch heart risks early

The Canadian Pediatric Society is recommending cholesterol screening for all children between the ages of two and 10.

A position statement released by the society on Friday said that atherosclerosis – the build-up of plaque in the arteries, which includes cholesterol – begins in childhood and is the leading cause of heart disease and stroke.

The statement’s lead author, pediatric cardiologist Dr. Michael Khoury, says about one in 300 Canadians has high cholesterol due to a genetic condition called familial hypercholesterolemia (FH).

He says universal screening with blood tests will help doctors identify the condition early and begin treatment, including changes in diet and physical activity.

Treating the condition in childhood can prevent cardiovascular disease from manifesting in adulthood, says Khouri, who specializes in preventive cardiology at Stollery Children’s Hospital in Edmonton and the University of Alberta.

He says that without universal screening, doctors are missing about 95 percent of children who have FH because children have no symptoms.

Dr. Alikhan Abdullah, a family physician in Manotick, Ontario, agrees that screening and preventive treatment are of great importance.

He said, “We need to start moving away from disease care, where we take care of sick people… We need to move more into areas of preventive health care.”

However, they are concerned about the impact any new screening would have on resources. He said conducting blood tests of thousands of children and providing proper follow-up would put pressure on an already strained system.

“(And) if we get these things — three-, four-, five-thousand new people, young kids who have high cholesterol — then we have to get them fitness help, dietetics help,” Abdullah said.

“Those things will be resource heavy, but they will be things we should invest in.”

What causes FH?

FH is usually caused by a mutation in the low-density lipoprotein cholesterol (LDL) receptor on the liver. The mutation prevents LDL cholesterol — often called “bad” cholesterol — from getting to the liver, says Khouri, so it accumulates in the blood.

This causes the liver to detect a “low cholesterol environment” and increase cholesterol production.

LDL cholesterol, along with fat and other substances, is a major component of plaque that builds up in arteries and restricts blood flow to the heart and brain.

If a child tests positive for FH, they are often referred to a pediatric lipid specialist like Khouri to monitor LDL cholesterol levels and begin treatment as needed.

Edmonton resident Mike Heathcote learned at an early age that he had high cholesterol, but it wasn’t until he grew up that doctors discovered he had the genetic mutation for FH.

Knowing there was a possibility of it progressing, she got both her son and daughter tested and discovered they also had the condition.

“They had healthy lifestyles, were active, just normal kids. If you hadn’t gotten tested, you would never have known,” he said.

By catching it early, Heathcote was able to get the medicine to his children.

He said, “Hopefully over time it will become such that this was never an issue for them. Their arteries will heal, there will be no long-term damage.”.

Her 15-year-old daughter, Haley Heathcote, says she’s grateful her FH was caught early.

“It’s as simple as a prick in the arm and you could save your life,” he said, referring to the blood test needed to diagnose FH.

Medicines for children ‘risks far outweigh the risks,’ doctor says.

Long-term safety data have shown that statin drugs commonly used to treat high cholesterol in adults can be given to children ages eight and older, often in lower doses, Khoury says.

“The benefits of using these drugs far outweigh the risks,” he said.

And Researchers have followed Children taking such medicines have a reduced risk of heart problems later in life.

“When you monitor these kids 20 years later, you can normalize their cardiovascular risk and, if we treat them adequately, remove the possibility that when they are in the prime of their lives, they have a significantly increased risk of having an early heart attack or stroke,” Khouri said.

The guidance to check cholesterol between the ages of two and 10 is intended to give primary care physicians as much opportunity as possible to perform blood tests, even though treatment with medication will not begin until age eight.

The child will usually remain on medication The rest of his life.

The American Academy of Pediatrics currently recommends cholesterol testing for all children ages nine to 11.

But pediatricians in the U.S. may recommend screening as early as age two if there are significant risk factors, including high blood pressure, obesity or diabetes, a known family history of FH, or a parent or grandparent with heart or cholesterol problems, the organization said.

According to Khoury, family doctors and pediatricians in Canada do not yet have a clear set of recommendations.