Lipid Screening Guidelines for Pediatric Patients

Universal Screening Recommendations

The American College of Cardiology/American Heart Association recommends that children without cardiovascular risk factors or family history of early cardiovascular disease should have lipid screening performed once between ages 9-11 years and again between ages 17-21 years 1, 2
Initial testing may be done with a nonfasting non-HDL cholesterol level with confirmatory testing with a fasting lipid panel if abnormal, as recommended by the American Diabetes Association 3
The American College of Cardiology/American Heart Association and the National Heart, Lung, and Blood Institute Expert Panel guidelines concur on the universal screening approach 4

Children with a family history of early cardiovascular disease or significant hypercholesterolemia should have lipid screening performed as early as age 2 years, according to the American College of Cardiology 1, 2
The American College of Cardiology also recommends that children with obesity or other metabolic risk factors should have lipid screening to detect disorders associated with metabolic syndrome 1, 2
Children with type 1 diabetes should have initial lipid profile performed soon after diagnosis, as recommended by the American Diabetes Association 3, 5

The American College of Cardiology recommends ages 9-11 years for initial screening because lipid levels are relatively stable before puberty, and atherosclerotic changes begin to diverge between affected and unaffected children around age 10 years 4, 6
The American College of Cardiology also recommends ages 17-21 years as the second screening point after puberty-related changes have stabilized 1, 2

If initial LDL cholesterol is ≤100 mg/dL, subsequent testing should be performed at 9-11 years of age, as recommended by the American Diabetes Association 3
The American Diabetes Association also recommends that if LDL cholesterol values are within accepted risk levels, repeating the lipid profile every 3 years is reasonable 3
For abnormal results, follow-up should include lifestyle counseling and potential referral to a specialist for severe abnormalities, according to the American College of Cardiology 1, 2

Early identification of children with genetic dyslipidemias through universal screening allows for reverse-cascade screening of family members to detect familial forms of hypercholesterolemia, as recommended by the American College of Cardiology 1, 2
Nonfasting lipid parameters are similar to fasting ones, making screening more practical in clinical settings, according to the American College of Cardiology 4
The goal of early identification and intervention is to reduce long-term cardiovascular risk, as recommended by the American College of Cardiology 4