Are parents' self-reported total cholesterol levels useful in identifying children with hyperlipidemia? An examination of current guidelines

Objective. Recently, the American Academy of Pediatrics (AAP) Committee on Nutrition adopted the recommendation of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents (NCEP) that children and adolescents with a family history of premature cardiovascular disease or parental hypercholesterolemia (≥240 mg/dL) be screened for hyperlipidemia. The rationale for using parental hypercholesterolemia as a screening trigger is based on sensitivity estimates using parents' actual lipid values. However, in clinical practice pediatricians may often have to rely on parents' self- reported cholesterol levels to determine a child's family risk history. This study examines the feasibility and utility of parental self-reported cholesterol levels as a means of identifying children with elevated total cholesterol levels. Methods. As part of a school-based risk factor screening program that included total cholesterol measurement, conducted in nine elementary schools between 1989 and 1991, parents of participating children were asked if they had their cholesterol tested in the past year and if they had, to provide their total cholesterol values. Results. If only the children who had one parent with a self-reported total cholesterol value ≥240 mg/dL would have been screened, between 90% and 93% of children with elevated total cholesterol values, either ≥170 mg/dL or ≥200 mg/dL, would have been missed. Conclusions. These data suggest that parents' self-reported cholesterol values are an ineffective means of identifying children with elevated total cholesterol and modification of the current AAP and NCEP guidelines for selective cholesterol screening in children may be warranted.