Research Article| Volume 17, ISSUE 2, P255-260, March 2023

Direct LDL-C estimation in preschoolers: Practicable first step for FH screening

Published:February 21, 2023DOI:


      • Direct LDL-C assay in children aged 2-6 years can be obtained in routine check-ups.
      • Family history for FH or premature CVD is not a reliable predictor in preschoolers.
      • On a population level positive family history is associated with higher LDL-C.


      Individuals with FH develop cardiovascular disease due to lifelong cumulative exposure to elevated LDL-C. Effective screening for FH is not yet established.


      To evaluate the practicability of a FH screening by measuring directly the LDL-C in preschoolers.


      LDL-C measurement through capillary blood sampling during the compulsory routine check-ups by the pediatrician in children aged 2 to 6 years including information on family history as dyslipidemia and/or premature cardiovascular disease in first and second grade of pedigrees.


      15,009 children (52.2% males, median age 3.9 years [IQR 3.0-5.1]) participated in the study. Positive family history for hyperlipidemia was stated in 40.9% cases, in 12.0% also in at least one 1st degree relative. In the total cohort, median LDL-C was 93 mg/dL [IQR 79-109 mg/dL]. Boys had significantly higher LDL-C levels than girls (p < 0.0001), whereas there was no difference regarding their age (p = 0.757). Children from families with a positive history for hypercholesterolemia/dyslipidemia had significantly higher LDL-C levels (p < 0.001) and were more frequently among those with LDL-C values above 135 mg/dL (3.5 mmol/L, 96th percentile; 53.2% vs. 40.3%, p < 0.001) and those with LDL-C levels above 160 mg/dL (4.1 mmol/L, 99th percentile; 45.3% vs. 40.7%, p < 0.001) than children without positive family history.


      Direct measurement of LDL-C levels in children at ages 2-6 years during the compulsory routine check-ups as well as at any voluntary visits to the pediatrician's office is practicable and delivers reliable information, which can be used for a FH screening strategy in the general population.



      ALDL (automated low density lipoprotein), BMI (body mass index), CVD (cardiovascular disease), FH (familial hypercholesterolemia), IQR (interquartile range), LDL-C (low-density lipoprotein cholesterol), Lp(a) (lipoprotein(a)), TC (total cholesterol)
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