III. The Individualized Approach: Detection/Diagnosis/Evaluation

The individualized approach to cholesterol lowering among children and adolescents focuses on those who appear to be destined to become adults with high blood cholesterol and an increased risk of coronary heart disease (CHD). This approach calls for the cooperative effort of the entire health professional team to identify, treat, and monitor individual children and adolescents who have high serum cholesterol levels, with the ultimate objective of preventing formation of atherosclerotic lesions in the coronary arteries. Because tracking of cholesterol levels from childhood to adulthood occurs but is imperfect, the panel sought ways to identify those children and adolescents whose elevated cholesterol levels are likely to indicate significant risk. The panel reached consensus that a low density lipoprotein (LDL)-cholesterol value of 130 mg/dL or higher (95th percentile), when associated with family history of cardiovascular disease (CVD) or parental hypercholesterolemia, is sufficiently elevated to warrant further evaluation and probable treatment and followup. The panel deliberately targeted the family unit and the familial aggregation of CVD and/or inherited lipid problems because hypercholesterolemia in a child from such a family is of clinical significance. Children with parents and grandparents who have premature CVD often have high cholesterol levels. Thus cholesterol levels in a child are linked to familial CVD.65,67,69,158 CHOLESTEROL MEASUREMENT: RECOMMENDATIONS FOR SELECTIVE SCREENING Who Should Have Cholesterol Measurements? The panel makes the following recommendations for the detection (selective screening), in the context of continuing health care, of children and adolescents likely to become adults with high blood cholesterol levels and increased risk for CVD.