TABLE 9-5

Evidence-Based Recommendations for Lipid Assessment

Birth to 2 yNo lipid screeningGrade C
Recommend
2 to 8 yNo routine lipid screeningGrade B
Recommend
Measure fasting lipid profile twice,a average results if:
    Parent, grandparent, aunt/uncle, or sibling withGrade B
    MI, angina, stroke, CABG/stent/angioplasty at <55 y in males, <65 y in femalesStrongly recommend
    Parent with TC ≥ 240 mg/dL or known dyslipidemiaGrade B
    Parent with TC ≥ 240 mg/dL or known dyslipidemiaStrongly recommend
    Child has diabetes, hypertension, BMI ≥ 95th percentile or smokes cigarettesGrade B Strongly recommend
    Child has a moderate- or high-risk medical condition (Table 5-2)Grade B Strongly recommend
    Use Table 9-1 for interpretation of results, algorithms in Figs 9-1 and 9-2 for management.
9 to 11 yUniversal screeningGrade B
Strongly recommend
    Non-FLP: Calculate non–HDL cholesterol:
    Non–HDL cholesterol = TC − HDL cholesterol
    If non-HDL ≥ 145 mg/dL ± HDL < 40 mg/dLb:
    Obtain FLP twice,a average results
    OR
    FLP:
    If LDL cholesterol ≥ 130 mg/dL ± non-HDL cholesterol ≥ 145 mg/dL ± HDL cholesterol < 40 mg/dL ± triglycerides ≥ 100 mg/dL if <10 y, ≥130 mg/dL if ≥10 y:
    Repeat FLP, average results
    Use Table 9-1 for interpretation of results, algorithms in Figs 9-1 and 9-2 for management.
12 to 16 yNo routine screeningcGrade B
Recommend
Measure FLP twice,a average results, if new knowledge of:
    Parent, grandparent with MI, angina, stroke, CABG/stent/angioplasty, sudden death at <55 y in male, <65 y in femaleGrade B
Strongly recommend
    Parent with TC ≥ 240 mg/dL or known dyslipidemiaGrade B
Strongly recommend
    Patient has diabetes, hypertension, BMI ≥ 85th percentile or smokes cigarettesGrade B
Strongly recommend
    Patient has a moderate- or high-risk medical condition (Table 5-2)Grade B
Strongly recommend
    Use Table 9-1 for interpretation of results, algorithms in Figs 9-1 and 9-2 for management.
17 to 21 yUniversal screening once in this time period:Grade B
Recommend
    Non-FLP: Calculate non–HDL cholesterol:
    Non–HDL cholesterol = TC − HDL cholesterol*
    17–19 y:
    If non–HDL cholesterol ≥145 mg/dL ± HDL cholesterol < 40 mg/dLb
    Measure FLP twice,a average results
    OR
    FLP:
    If LDL cholesterol ≥ 130 mg/dL ± non–HDL cholesterol ≥ 145 mg/dL ± HDL cholesterol < 40 mg/dL ± triglycerides ≥ 130 mg/dL
    Repeat FLP, average results
    Use Table 9-1 for interpretation of results, algorithms in Figs 9-1 and 9-2 for management.
    20–21 y:
    Non–HDL cholesterol ≥ 190 mg/dL ± HDL cholesterol < 40 mg/dL
    Measure FLP twice, average results
    OR
    FLP:
    If LDL cholesterol ≥ 160 mg/dL ± non–HDL cholesterol ≥ 190 mg/dL ± HDL cholesterol < 40 mg/dL ± triglycerides ≥ 150 mg/dL
    Repeat FLP, average results
    Use Table 9-2 for interpretation of results, Adult Treatment Panel (ATP III) algorithm for management.
  • Grades reflect the findings of the evidence review, recommendation levels reflect the consensus opinion of the expert panel. Note that the values given are in mg/dL. To convert to SI units, divide the results for TC, LDL cholesterol, HDL cholesterol, and non-HDL cholesterol by 38.6; for triglycerides, divide by 88.6. MI indicates myocardial infarction; CABG, coronary artery bypass graft; ATP III, Adult Treatment Panel III.

  • a Interval between FLP measurements: after 2 weeks but within 3 months.

  • b Use Table 9-1 for interpretation of results; use lipid algorithms in Figs 9-1 and 9.2 for management of results.

  • c Disregard triglyceride and LDL cholesterol levels in nonfasting sample.

  • d Lipid screening is not recommended for those aged 12 to 16 years because of significantly decreased sensitivity and specificity for predicting adult LDL cholesterol levels and significantly increased false-negative results in this age group. Selective screening is recommended for those with the clinical indications outlined.

  • eUse Table 9-1 for interpretation of results of 7- to 19-year-olds and lipid algorithms in Figs 9-1 and 9-2 for management. Use Table 17 for interpretation of results of 20- to 21-year-olds and ATP III algorithms for management.