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PEDIATRICS Vol. 113 No. 6 June 2004, pp. 1723-1727

Usefulness of the American Academy of Pediatrics Recommendations for Identifying Youths With Hypercholesterolemia

Jennifer O’Loughlin, PhD*,{ddagger}, Beatrice Lauzon, BSc*, Gilles Paradis, MD*,{ddagger},§, James Hanley, PhD{ddagger}, Emile Lévy, PhD||,¶, Edgar Delvin, PhD,# and Marie Lambert, MD**,{ddagger}{ddagger}

* Direction de santé publique de Montréal-Centre, Montreal, Quebec, Canada
{ddagger} Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
§ Division of Preventive Medicine, McGill University Health Center, Montreal, Quebec, Canada
|| Department of Nutrition, University of Montreal, Montreal, Quebec, Canada
Research Center, Ste-Justine Hospital, Montreal, Quebec, Canada
# Department of Clinical Biochemistry, Ste-Justine Hospital and University of Montreal, Montreal, Quebec, Canada
** Division of Medical Genetics, Ste-Justine Hospital, Montreal, Quebec, Canada
{ddagger}{ddagger} Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada

Objective. To determine the usefulness of parent history of hypercholesterolemia and cardiovascular disease as a screening criterion for hypercholesterolemia in youths.

Methods. Data were available from a population-based survey of 3665 Quebec youths aged 9, 13, and 16 years (81.2% of eligible subjects). Blood specimens were collected from 2475 subjects (54.8% of those eligible), and questionnaire data were obtained from 3048 parents (67.5% of those eligible). Lipids were measured in a Centers for Disease Control and Prevention standardized laboratory. Usefulness of parent history in identifying borderline/high low-density lipoprotein cholesterol (LDL-C) (≥2.8 mmol/L [≥110 mg/dL]) and high LDL-C (≥3.4 mmol/L [≥130 mg/dL]) was assessed according to test performance statistics (sensitivity, specificity, positive predictive value, and negative predictive value).

Results. The prevalence of a positive parent history was 25.6%; 18.3% of subjects had borderline/high LDL-C, and 4.8% had high LDL-C. Sensitivity, specificity, positive predictive value, and negative predictive value of parent history were 33.1%, 76.0%, 23.7%, and 83.5%, respectively, for identifying borderline/high LDL-C; they were 40.7%, 75.1%, 7.7%, and 96.1% for identifying high LDL-C. Test performance statistics were not improved in subgroups defined according to age, gender, parent education, household income, family status, and family origin (French Canadian, other); neither were they improved by adding screening criteria (parent history of diabetes or hypertension, or youth overweight).

Conclusion. Parent history screening criteria offer little improvement over random population screening in identifying youths with hypercholesterolemia.

Key Words: screening • children • adolescent • cholesterol • family history • sensitivity • specificity • positive predictive value • negative predictive value

Abbreviations: CVD, cardiovascular disease • AAP, American Academy of Pediatrics • LDL-C, low-density lipoprotein cholesterol • PPV, positive predictive value • QCAHSS, Quebec Child and Adolescent Health and Social Survey • CV, coefficient of variation • TC, total cholesterol • TG, triglycerides • NPV, negative predictive value

Received for publication Aug 7, 2003; Accepted Jan 9, 2004.




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