PUBLIC HEALTH

Child-Parent Cholesterol Screening Found Effective

Child–parent hypercholesterolemia (FH) screening is a practical and effective way of conducting population-based screening to identify the condition associated with premature cardiovascular disease, according to a study published Oct. 27 in the New England Journal of Medicine. Screening for both cholesterol and genetic mutations found that about one in 270 kids has FH, which is higher than previous estimates.

The researchers used a strategy that screens young children (aged one to two years) for cholesterol during routine immunization visits. This offered the advantage of eliminating the need for an additional office visit and occurred at a time when measurement of cholesterol is most discriminatory. Parents were only screened if a child had positive results.

In the study, more than 10,000 children were screened (March 2012 through March 2015) at 92 general medical practices in the United Kingdom. Heel-stick capillary blood samples were used for both measurement of cholesterol and for testing for FH mutations in children. All children were tested for 48 FH (FH48) mutations.

In addition to being effective, the authors say their FH screening strategy is affordable. They estimate cholesterol testing costs $7 and DNA sequencing costs $300 per sample, yielding a cost of $2,900 per person identified as having positive screening results for FH, without an additional service delivery cost when screening is combined with immunization.

“This is the first demonstration that child-parent screening works on a large scale,” said lead author David Wald, F.R.C.P., from the Queen Mary University of London in the United Kingdom, in a statement. “It’s the only screening method that stands a reasonable chance of covering the whole population and identifying those at highest risk of an early heart attack.”

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