Hypercholesterolemia in adolescents: effectiveness of screening strategies based on selected risk factors

This study evaluates the efficacy of the American Academy of Pediatrics' current recommendations for identifying hypercholesterolemia in teenagers. These guidelines advocate a screening strategy that is targeted only at high-risk individuals. Detailed information regarding risk factors for hypercholesterolemia was obtained from 1001 adolescents or their parents at three urban teen clinics during routine health assessments. In addition, serum cholesterol was measured in all adolescents. The population under study was 38.2% Hispanic, 33.5% white, 15.4% black, and 11.3% Asian, with a mean age of 15.6 years (range: 12 through 21 years); 52% were female. Based on the cholesterol values, the study population was divided into two groups: (1) normal cholesterol level, <200 mg/dL (n = 937, mean cholesterol value = 157 mg/dL) and (2) elevated cholesterol level, greater than or equal to 200 mg/ dL (n = 64, mean cholesterol value = 228 mg/dL, range = 200 through 366 mg/dL). Application of the 1985 American Academy of Pediatrics criteria for selected screening identified 30 of 64 individuals with hypercholesterolemia (sensitivity = 47%). Criteria similar to 1988 recommendations identified 40 of 64 teenagers (sensitivity = 62%). A combination of 1985 and 1988 criteria yielded a sensitivity of 44 of 64, or 69%. The specificity of these criteria was 74%, 60%, and 53%, respectively. Despite the utilization of the 1985, 1988, or a combination of both American Academy of Pediatrics criteria for hypercholesterolemia screening, this study demonstrates that many adolescents with abnormal cholesterol levels would not be identified. Rather than relying on selected screening which is targeted at high-risk individuals, practitioners should consider cholesterol screening in all adolescents as part of a routine health assessment.