Docs Say First Cholesterol Test Should be Done by Age 11?

CHICAGO (The Blaze/AP) -- Cholesterol tests are something 30 somethings think about -- maybe 20 somethings if they have a history of heart disease. But a panel of doctors are saying tests should happen decades earlier.

An expert panel appointed by the National Heart, Lung and Blood Institute and endorsed by the American Academy of Pediatrics is recommending in its new guidelines that every child between age 9 and 11 should be tested for high cholesterol so steps to prevent heart disease down the road can be taken sooner, if need be.

This could become controversial with regard to prescribing cholesterol-lowering drugs. The doctors are saying that odds are less than 1 percent of children would need the drugs and that those younger than 10 should not take medication to lower cholesterol unless the case is severe. In most cases, diet and exercise should suffice.

Until now, major medical groups have suggested cholesterol tests only for children with a family history of early heart disease or high cholesterol and those who are obese or have diabetes or high blood pressure. But studies show that is missing many children with high cholesterol, and the number of them at risk is growing because of the obesity epidemic.

They also advise diabetes screening every two years starting as early as 9 for children who are overweight and have other risks for Type 2 diabetes, including family history.

Autopsy studies show children already have signs of heart disease even before they have symptoms. By the fourth grade, 10 percent to 13 percent of U.S. children have high cholesterol, defined as a score of 200 or more.

Fats build up in the heart arteries in the first and second decade of life but usually don't start hardening the arteries until people are in their 20s and 30s, said one of the guideline panel members, Dr. Elaine Urbina, director of preventive cardiology at Cincinnati Children's Hospital Medical Center.

"If we screen at age 20, it may be already too late," she said. "To me, it's not controversial at all. We should have been doing this for years."

Doctors recommend testing between ages 9 and 11 because cholesterol dips during puberty and rises later.

The guidelines also say doctors should:

-Take yearly blood pressure measurements for children starting at age 3.

-Start routine anti-smoking advice when kids are ages 5 to 9, and advise parents of infants against smoking in the home.

-Review infants' family history of obesity and start tracking body mass index, or BMI, a measure of obesity, at age 2.

The panel also suggests using more frank terms for kids who are overweight and obese than some government agencies have used in the past. Children whose BMI is in the 85th to 95th percentile should be called overweight, not "at risk for overweight," and kids whose BMI is in the 95th percentile or higher should be called obese, not "overweight - even kids as young as age 2, the panel said.

"Some might feel that `obese' is an unacceptable term for children and parents," so doctors should "use descriptive terminology that is appropriate for each child and family," the guidelines recommend.

The guidance was released online Friday by the journal Pediatrics and will be presented Sunday at an American Heart Association conference in Florida.