Lipid Profile Screening in Adolescents with Family History of Dyslipidemia

Justification for Repeated Screening

The American Heart Association and American Diabetes Association recommend that children with a family history of hypercholesterolemia or early cardiovascular events should undergo lipid profile screening at the age of 2, and again at puberty (≥12 years), regardless of previous results 1, 2, 3
For prepubescent children, a fasting lipid profile should be performed at the age of 2 if there is a family history of hypercholesterolemia (total cholesterol ≥240 mg/dL) or early cardiovascular events (before 55 years) 2, 3
For pubescent children (≥12 years), a new fasting lipid profile should be performed at puberty, even if previous values were normal 2, 3

If lipid values are within acceptable limits (LDL <100 mg/dL), screening should be repeated every 5 years 2, 3, 4
The American College of Cardiology/American Heart Association 2018 guidelines define the following thresholds for intervention in children and adolescents: LDL-C ≥190 mg/dL or ≥160 mg/dL with clinical presentation compatible with familial hypercholesterolemia, consider statin treatment after 3-6 months of lifestyle therapy in patients ≥10 years 1
LDL-C ≥130 mg/dL: intensive dietary intervention for 6 months before considering pharmacological treatment 6, 7

If abnormal values are detected in the patient, it is reasonable to perform cascade screening of family members, including cholesterol tests for first-, second-, and if possible, third-degree biological relatives to detect familial forms of hypercholesterolemia 1

Cholesterol levels vary significantly by sex and age during childhood, with total cholesterol levels increasing from birth, stabilizing around 2 years, peaking before puberty, and decreasing slightly during adolescence 5
Longitudinal tracking of lipids from childhood to adulthood is modest, with a positive predictive value of only 32.9% to 37.3% for high LDL-C levels in adolescence predicting high levels 15-20 years later 5