Screening for cholesterol may not be worth effort, expense

Should I screen my otherwise healthy children for cholesterol?

I have two thoughts about this. First, how worried should we be about cholesterol in kids, and second, how much screening should we do?

Usually we think about cholesterol as being bad, and generally when it is high, this is so. But a more accurate way would be to know whether our blood lipids are off. The talk of "good cholesterol" and "bad cholesterol" is valid. But the most important factor in your blood lipid profile is your genetics. There is not that much you can do with diet and exercise.

New recommendations from the American Academy of Pediatrics are to screen kids who have a family history of abnormal lipid profile, plus any child who has a close relative with an early cardiac event (younger than 55 for males, younger than 65 for females). Also, any child who is above the 85th percentile for body mass index should be screened.

Kids who fall into these categories should be screened twice between age 2 and 10. The organization also recommends no more whole milk for children starting at 1 year old.

What has spurred this is the idea that we should be using more anti-cholesterol drugs in childhood. While I am dubious that diet would do much good to change abnormal lipid profiles, it's also a little out of place that someone might be on a statin drug for decades. I would like to see more data.

Exercise is always a good idea in any family with coronary artery disease.

So why screen? I remember vividly a 5-year-old girl whose father had had a heart attack at an early age. He had abnormal lipids. So we screened her, and her lipids came back as bad as her dad's. But after consulting with cardiologists, nutritionists and endocrinologists, we did nothing. Everyone was distraught. This family likely felt a little more urgency to do the things we all should do: eat right, get exercise, sleep, etc. But I am not sure if it did a lot of good or not. We, meaning the medical profession, are in a screening frenzy these days. All of the screens presently in use have their benefits. Isn't it better to know something than not know it? However, there can be a downside to this bevy of screening, mostly in worry and stress.

Because I am a physician and am on staff at Children's Hospital, I am required to get an annual TB skin test. I now do developmental and behavioral health, and I am no more likely to get TB than a grocery store clerk. I don't have any contact with the sick public, at least not the infectious sick public. When people are sick, they cancel appointments.

But probably this blanket recommendation makes sense because it is so darned cheap; about $3 for the test materials. If TB skin tests cost $200 apiece, I'll bet we wouldn't do it like this.

The cholesterol screening is one that is dubious in its value and will help only a small percentage of kids. Couldn't this time and expense be better spent building a healthier society, for all kids, who are developing their life habits? So when you ask the question, is it worth it to screen all these kids for lipid problems, it seems like a straightforward medical question.

But it isn't. It's at least as much a societal question, and an economic one as well. Suppose you have to spend, between lab costs and personnel time, $20,000 to find a kid who's at risk. And suppose you knew that using a statin drug very likely would help. You don't know that the health care system might be able to do more with that money to fight heart disease; more gym memberships, better education, more research, obligatory salads, etc.

What I would like you to do, as critical consumers, is to appraise this policy and others like this. What exactly are we doing and what is the price we pay, not just economically, but in fear and anxiety.

And I will say right now that, without the data, I don't know whether this is a good idea or not.