Doctors still resist routine testing of youngsters

ANAHEIM, Calif. (AP)—Doctors will resist testing every child for unhealthy cholesterol levels, despite a study that suggests two-thirds of youngsters at risk of heart disease go undetected, experts said Tuesday.

“The study is great” but further research will be needed to convince pediatricians that all youngsters should get a blood cholesterol test, said nutritionist Mary Winston, a senior science consultant for the American Heart Association.

“These (heart) diseases clearly begin in childhood and progress,” said Dr. Gerald Berenson, cardiology chief at Louisiana State University Medical Center. “The problem is how to get the pediatricians interested in beginning preventive cardiology in childhood.”

The study was presented Monday at the American College of Cardiology’s annual scientific session by Dr. Dennis Davidson, chief of preventive cardiology at the University of California, Irvine.

He said testing all school children would let doctors “detect all children in the upper ranges of high cholesterol and help families change their diet to lower the risk to the children.”

The American Heart Association and American Academy of Pediatrics now recommend childern’s blood cholesterol levels tested only if they have a family history of early heart attack or excess blood cholesterol.

Yet Davidson said his study of 612 children in Westminster “found that using the existing guidelines for screening, we identified only one-third of the childern with blood cholesterol already at a level undersirable for adults and certainly undesirable for kids.”

Cholesterol is a waxy substance that can contribute to clogged arteries and heart disease, depending on what type of fatty proteins carry it through the blood.

Pediatricians now recommend a low-fat diet for prepubescent childern older than 2 with blood cholesterol over 176, Davidson said. The Heart Association says that in adults, cholesterol levels above 240 are high, while those under 200 are desirable.

Berenson’s own continuing landmark study of 10,000 young people in Bogalusa, La., found signs of future heart disease start at a young age. Prevention efforts are important in childhood, said Dr. Arthur Carson, pediatric cardiology chief at Baylor College of Medicine in Houston.

Winston, howerver, said “doctors are just not ready” for a mass testing of children because they fear it might spur overuse of cholesterol-lowering drugs.

Pediatricians also argue that mass cholesterol testing of children could prompt overuse of diets, perhaps harming normal growth and development, and that there is no proof changing diet in childhood will prevent adult heart disease.

But doctors can’t wait for decades “to come up with the ultimate proof without writing of a generation or two,” said Dr. David Blankenhorn, director of atherosclerosis research at the University of Southern California.

Berenson, who previously has urged mass testing of childern, said Davidson’s findings are similar to his in Bogalusa, where half the children at risk for future heart disease failed to report any family history of such ailments.