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There's a new study out this week suggesting that testing all children for cholesterol could identify many who are already showing signs of heart disease. Currently, such tests are reserved for children who have family histories of heart disease.

NPR's Patti Neighmond reports on the controversy over when and why to test children for high cholesterol.

PATTI NEIGHMOND: Dr. Reginald Washington is a pediatric cardiologist with the Rocky Mountain Hospital for Children in Denver. He says the sooner the better when it comes to testing for cholesterol. If kids are tested and diagnosed as early as age 10, then treatment, says Washington, can save lives and health care costs down the road by helping prevent hardening of the arteries.

Dr. REGINALD WASHINGTON (Pediatric Cardiologist, Rocky Mountain Hospital for Children): So if you have a high cholesterol as a child, that buildup begins when you're a child. It doesn't wait until your 40 or 35 to begin to have a buildup. That buildup is cumulative.

So it makes sense if you can prevent that buildup from starting in the first place, that coronary artery is going to be normal as you get older.

NEIGHMOND: Washington points to research showing 70 percent of children with high cholesterol grow into adults with high cholesterol. In West Virginia, Dr. William Neal, also a pediatric cardiologist, wanted to see what would happen if all kids over the age of 10 were tested for cholesterol, not just those with a family history.

He analyzed cholesterol tests for more than 20,000 fifth graders. His findings were somewhat surprising. If only kids with family histories had been tested, Neal says they would have missed a lot of kids.

Dr. WILLIAM NEAL (Pediatric Cardiologist): We would have missed 548 children who had abnormal cholesterol levels. And of those 548, 98 would have had severe elevation of cholesterol, requiring medication.

NEIGHMOND: Medication like adults take to lower their cholesterol. While studies have shown these cholesterol-lowering drugs are effective for adults and mostly safe with relatively rare side effects, there have been no studies showing the drugs' safety and effectiveness in children over the long term, which is why the first line of defense against high cholesterol, says Neal, is a healthy lifestyle.

Dr. NEAL: Low-saturated-fat diet, at least one hour of exercise most days of the week for children.

NEIGHMOND: After monitoring for about six months, if lifestyle changes don't work to lower cholesterol, then Neal says doctors may want to consider medication. He says testing all children for high cholesterol is an important tool to help prevent heart disease later in life. But some health experts worry widespread testing is premature and not always beneficial.

Pediatrician Matthew Gillman specializes in childhood obesity at Harvard Medical School.

Dr. MATTHEW GILLMAN (Pediatrician, Harvard Medical School): When kids get tested for cholesterol, they get follow-up tests, and they get recommendations. And these things may cause some side effects, and they cost something. And so we have to think about not only the benefits but also the costs and the risks throughout a whole lifetime when we test kids in childhood.

NEIGHMOND: Gillman adds that when all children are tested, there's a risk of finding and treating individuals with relatively high cholesterol who may never have a problem later in life. Cholesterol levels are only one risk factor for heart disease.

Both Gillman and pediatric cardiologist Reginald Washington serve on a federal panel that's considering whether to recommend testing all children for cholesterol. Those recommendations are expected by the end of this year.

Patti Neighmond, NPR News.

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