Cholesterol screening in the adolescent.
Guidelines for screening populations for hypercholesterolemia are controversial. In pediatric patients, screening has been targeted to those with a family history of hypercholesterolemia or early myocardial infarction. Because specific guidelines for adolescents have not been developed, we undertook a study of cholesterol screening in 224 consecutive patients (mean age, 14.8 +/- 2.2 years; range, 11-20 years). In this study, 33 (14.7%) adolescents had levels above 185 mg/dL; 71 (32.7%) of the patients reported a positive family history for early myocardial infarction or elevated lipids. A positive family history obtained from the adolescent patient had a 36% sensitivity, 69% specificity, 17% positive predictive value, and an 87% negative predictive value compared with elevated cholesterol level. A positive history reported by the parent had a 65% sensitivity, 46% specificity, 16% positive predictive value, and an 89% negative predictive value. A positive family history obtained from either parent or adolescent had a 45% sensitivity, 69% specificity, 19% positive predicative value, and 89% negative predictive value. Family history by the adolescent was significantly different from parental history (p < 0.001). Family history is a poor predictor for cholesterol level in adolescents.
Gagliano
N J
NJ
Division of Adolescent/Young Adult Medicine, Children's Hospital, Boston, MA.
Emans
S J
SJ
Woods
E R
ER
D000293:Adolescent; D016497:Adolescent Health Services / Q000592:standards*; D000328:Adult; D001900:Boston; D002648:Child; D002985:Clinical Protocols / Q000592:standards; D003276:Contraceptives, Oral / Q000009:adverse effects; D005069:Evaluation Studies as Topic; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards*; D008487:Medical History Taking / Q000592:standards*; D044469:Racial Groups; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012907:Smoking / Q000009:adverse effects
D003276:Contraceptives, Oral