Many young adults, kids need but lack cholesterol screening

Signs of heart disease — generally thought to be a disease of middle age — can be seen even in children, cardiologists now know. But risk factors in children and young adults run the risk of being undetected and untreated, largely because of confusion as to who among the young should get screened, and when.

One of the most efficient ways to screen for heart-disease risk is via tests for levels of low-density lipoprotein (LDL, or "bad") cholesterol. And yet often that screen doesn't get done.

In a study published in the July-August issue of the Annals of Family Medicine, Dr. Elena Kuklina and colleagues from the Centers for Disease Control and Prevention examined data from the 1999-2006 National Health and Nutrition Examination Survey, a national survey that includes interviews and physical examinations, to see how frequently young adults were getting screened for LDL cholesterol.

Of the 2,587 young adults in the study — men 20 to 35 years old and women 20 to 45 — fewer than 50 percent had been screened. Yet 59 percent of them had heart disease or related conditions such as diabetes or at least one risk factor for heart disease (such as obesity, high blood pressure, smoking or a family history of heart disease before age 50).

The study also reported that 65 percent of young adults with heart disease or related conditions had unhealthily high LDL cholesterol levels, as did 26 percent of those with two or more risk factors, 12 percent with one risk factor and 7 percent with no risk factors.

"This is a big problem," said Kuklina, a fellow at the CDC's division of heart disease and stroke prevention. "Heart disease and risk factors are common in young adults, and yet screening rates are low."

It turns out that doctors themselves don't know what to do about the screening issue because two different guidelines exist for screening adults for cholesterol. "Doctors are confused about which guideline to follow, and insurance companies may not cover screenings depending on what guidelines they follow," Kuklina said.

One set of guidelines, supported by the American Heart Association and the National Heart, Lung and Blood Institute, is from the National Cholesterol Education Program. It recommends screening young adults, regardless of risk level, every five years once they turn 20.

Another set of guidelines, by the U.S. Preventive Services Task Force, recommends screening all men 35 and older and all women 45 and older. It recommends earlier screening only if a person already has heart disease or at least one risk factor.