New heart-health guidelines urge cholesterol screening starting at age 9

Heart health is no longer just a concern for the elderly or even young adults. A new set of guidelines recommends cholesterol screening to begin for children in the nine-to-11 age group. It also suggests qualified patients as young as 30 begin taking medication—statins—to lower their cholesterol level. 

"The longer an individual's arteries are exposed to plaque-causing lipoproteins, the greater the long-term risk. The earlier you intervene, the more you bend the curve and delay the onset of atherosclerosis or plaque," said Dr. Pamela Bowe Morris, professor of medicine at the Medical University of South Carolina. Morris served as the vice chair of the guidelines-writing committee. 

The new set of guidelines, published on March 13, eight years after the last report, was a collaborative effort by 11 organizations, including the American Heart Association, the American College of Cardiology, and the American College of Preventive Medicine. Experts used data gathered from about 6.5 million people, and spent 20 months producing the new guidelines. 

The comprehensive guidelines, published in the Journal of the American College of Cardiology, were written to help doctors and their patients draw up more individualized treatment plans for heart disease. 

Identifying cholesterol risk

The new guidelines give recommendations based on patients' risk for dyslipidemia, a condition that involves extraordinarily high levels of bad cholesterol. 

Risk factors include: a family history of heart disease, inflammatory conditions, such as lupus or rheumatoid arthritis, obesity, HIV, early menopause, preeclampsia, gestational diabetes, and being of South Asian or Filipino ancestry. Other factors considered are the patient's age, gender, cholesterol intake, and smoking habits. 

But the authors of the paper warn against self-diagnosis based on known risk factors. It is always best to seek a doctor's diagnosis, especially if there is heart disease in the family. 

“Lipoprotein(a) (i.e., particles made of protein and fat that transport cholesterol through the bloodstream) is an inherited form of lipoprotein. Your levels are determined by your genetics; you don’t have to do anything naughty to get it,” said Morris.  

Early intervention

One of the paper's main points emphasizes the importance of early intervention, even for cholesterol levels. 

According to the World Health Organization, heart disease leads to 13% of deaths worldwide, approximately 17.9 million, making it the leading cause of global mortality. In the Philippines, based on data from the Philippine Statistics Authority, coronary artery diseases accounted for 19.4%, approximately 85,686 deaths from January to October 2024. 

However, experts, including the WHO, say most cardiovascular diseases can be prevented through medication and a healthy lifestyle, with regular exercise, a balanced diet, and abstinence from smoking and alcohol. If the patient presents numerous risk factors for heart disease, however, statins, or medications that lower bad cholesterol levels, are key; an adjusted diet may help, but cannot singelhandedly reverse the symptoms. 

Cholesterol screening

Early lipoprotein screening—a blood test that measures the level of bad cholesterol in the blood—is not a new concept for children. According to Morris, doctors had been recommending it since 2011 for preteen children, but parents did not take the advice seriously. 

"We are re-emphasizing that because the uptake on it has been dismal. The reason is so that you can intervene early with lifestyle factors, and in addition, identify those children with potential genetic lipid disorders," said Morris. 

The guidelines say that childhood lipid screening can identify Familial Hypercholesterolemia, which is a common genetic disorder that causes abnormally high levels of bad cholesterol from birth. 

In adults, the guidelines suggest screening with a lipid profile beginning at age 19, and every five years thereafter, to detect risks of atherosclerotic cardiovascular disease, which is the build-up of high-cholesterol plaque in arterial walls. If left untreated, the plaque can eventually restrict blood flow. 

It is advisable to keep a watchful eye on one's heart health, and the new guidelines suggest starting this habit early with your children. The evidence is here; what we need to do is to heed its warning.