| Study, year | Population - N, age |
Method | Thresholda | Sensitivity | Specificity | Number eligible for screening (based on population of 1,000)b | Number missed (based on population of 1,000)b | Comments |
|---|---|---|---|---|---|---|---|---|
| Bell, 199061 | 1,140 5th graders | Family history of high cholesterol or MI < age 60 in parent or grandparent |
Non-fasting TC > 200 mg/dL | 64% | 47% | 540 | 46 | |
| 1,140 5th graders | As above, plus family history of stroke, angina or hypertension |
Non-fasting TC > 200 mg/dL | 77% | 24% | 760 | 31 | ||
| Davidson, 199162 | 1,118 4th graders | Family history from parents (regarding parents, siblings, grandparents, aunts, uncles); early MI defined as < age 56 for men and women | TC > 200 mg/dL | 41% | 68% | 330 | 83 | RR of 48% |
| 1,118 4th graders | Parental questionnaire, definition using AAP criteria for early CHD (< age 50 for men, < age 60 for women) |
TC > 200 mg/dL | 31% | 66% | 330 | 96 | ||
| Dennison, 198972 |
1,214, ages 4-10, Bogalusa Heart Study | Parental questionnaire asking parental history of any vascular disease (CHD, HTN, diabetes, stroke) | Fasting TC > 95th percentile | 38% for W; 27% for AA | 73% for W; 65% for AA | N/A | N/A | |
| 2,099, ages 11-17, Bogalusa Heart Study | Parental questionnaire asking parental history of any vascular disease (CHD, HTN, diabetes, stroke) | Fasting TC > 95th percentile | 59% for W; 25% for AA | 67% for W; 56% for AA | N/A | N/A | ||
| 1,214,ages 4-10, Bogalusa Heart Study | Parental questionnaire asking parental history of any vascular disease (CHD, HTN, diabetes, stroke) | Fasting LDL > 95th percentile | 41% for W; 20% for AA | 73% for W; 63% for AA | N/A | N/A | ||
| 2,099, ages 11-17, Bogalusa Heart Study | Parental questionnaire asking parental history of any vascular disease (CHD, HTN, diabetes, stroke) | Fasting LDL > 95th percentile | 37% for W; 22% for AA |
67% for W; 56% for AA | N/A | N/A | ||
| Diller, 199563 | 232, ages 2-19, Cincinnati MI Hormone Study | Parental questionnaire using NCEP definition of family history of premature CVD | LDL > 130 mg/dL | 17% | 75% | 246 | 207 | |
| 232, ages 2-19, Cincinnati MI Hormone Study | Parental questionnaire asking family history of cholesterol > 240 | LDL > 130 mg/dL | 61% | 74% | 293 | 99 | ||
| 232, ages 2-19, Cincinnati MI Hormone Study | Both family history of elevated cholesterol and premature CVD | LDL > 130 mg/dL | 74% | 55% | 478 | 65 | ||
| 232, ages 2-19, Cincinnati MI Hormone Study | Other indicators: obesity, smoking, use of lipid raising medications, high fat diet, HTN | LDL > 130 mg/dL | 17.4% for obesity, 9-48% for others | 86% for obesity, 69-95% for others | 547 | 86 | ||
| 232, ages 2-19, Cincinnati MI Hormone Study | Family history of premature CHD (NCEP definition), TC > 240 mg/dL, or any other risk factor (obesity, smoking, lipid raising medication, high fat diet or HTN). | LDL > 130 mg/dL | 96% | 28% | 746 | 13 | ||
| Gagliano, 199364 | 224, ages 11-20 | Family history of early MI (< age 50 for men, < age 60 for women) or elevated lipids (TC > 200 mg/dL), history obtained from adolescent | TC > 85th percentile for gender | 36% | 69% | 320 | 94 | |
| 224, ages 11-20 | Family history as above, history obtained from parent | TC above the 85th percentile for gender | 65% | 46% | 589 | 54 | ||
| 224, ages 11-20 | Use of combined family history from adolescent and parent | TC above the 85th percentile for gender | 45% | 69% | 361 | 80 | ||
| Griffin, 198965 | 1,005, ages 2-13, 8 office practices | Parent and grandparent history of hypercholesterolemia or CHD < age 55 | Fasting LDL > 95th percentile | 46% | NR | N/A | 147 | |
| 1,005, ages 2-13, 8 office practices | Parent and grandparent history of any risk factor or complication (hypercholesterolemia, diabetes, HTN, gout, obesity and atherosclerosis prior to age 55) | Fasting LDL > 95th percentile | 78% |
NR | N/A | 59 | ||
| 1,005, ages 2-13, 8 office practices | Parent and grandparent history of hypercholesterolemia or CHD < age 55 | Fasting LDL > 90th percentile | 51% | 63% | 385 | 48 | 51% of children with elevated LDL would have been detected by AAP screening criteria.; specificity calculated. | |
| 1,005, ages 2-13, 8 office practices | Any history of parent or grandparent with a risk factor or complication (hypercholesterolemia, diabetes, HTN, gout, obesity and atherosclerosis prior to age 55) | Fasting LDL > 90th percentile | 80% 38% for high cholesterol alone 31% for obesity 18% for sudden death 17% for gout 13% for PVD |
37% | 650 | 20 | specificity calculated | |
| 1,005, ages 2-13, 8 office practices | Overweight (weight for height >> 95th percentile) plus family history of early CHD or hypercholesterolemia | Fasting LDL > 90th percentile | 57% | NR | N/A | 42 | ||
| 1,005, ages 2-13, 8 office practices | Overweight (weight for height > 95th percentile) plus family history any risk factor or complication | Fasting LDL > 90th percentile | 84% | 31.0% | 704 | 16 | specificity calculated | |
| Muhonen, 199466 | 599, ages 14-20, Muscatine, IA | Parental history of high cholesterol | Highest decile of fasting TC | 34% | 76% | N/A | N/A | "unsure" responses were not included in calculations of sensitivity/specificity |
| 599, ages 14-20, Muscatine, IA | Parental history of high cholesterol | Highest decile of fasting LDL | 34% | 76% | N/A | N/A | ||
| 599, ages 14-20, Muscatine, IA | Parental history of high cholesterol | Lowest decile of fasting HDL | 26% | 75% | N/A | N/A | ||
| O'Loughlin, 200473 | 2,217, ages 9, 13, and 16, Quebec | Parental questionnaire asking personal history of 1) high cholesterol 2) medications for cholesterol 3) heart attack, angina, 4) stroke, CVD or PVD or 5) medications for the heart; unknown family history coded as negative | Fasting LDL > 109 mg/dL ("borderline") | 33% | 76% | 256 | 44 | |
| 2,217, ages 9, 13, and 16, Quebec | Parental questionnaire asking personal history of 1) high cholesterol 2) medications for cholesterol 3) heart attack, angina, 4) stroke, CVD or PVD or 5) medications for the heart; unknown family history coded as negative | Fasting LDL > 131.5 mg/dL, ("high") | 41% | 75% | 256 | 12 | ||
| 2,217, ages 9, 13, and 16, Quebec | Parental questionnaire asking personal history of 1) high cholesterol 2) medications for cholesterol 3) heart attack, angina, 4) stroke, CVD or PVD or 5) medications for the heart; unknown family history excluded | Fasting LDL > 109 mg/dL, ("borderline") | 42% | 70% | N/A | 85 | ||
| 2,217, ages 9, 13, and 16, Quebec | Parental questionnaire asking personal history of 1) high cholesterol 2) medications for cholesterol 3) heart attack, angina, 4) stroke, CVD or PVD or 5) medications for the heart; unknown family history excluded | Fasting LDL > 131.5 mg/dL, ("high") | 51% | 69% | N/A | 19 | ||
| Primrose, 199467 | 1,012, ages 12-15, Ireland | History of stroke, angina or heart attack in either parent at any age or in 1st degree grandparents, uncles or aunts < age 55. Questionnaires completed by parents |
Non-fasting TC > 95th percentile according to LRC | 33% | 72% | 293 | 125 | |
| Resnicow, 199368 | 574, elementary school age | Parental cholesterol > 240 in 1 parent only with known and reported value by that parent | Non-fasting TC > 200 mg/dL | 10% | 91% | 90 | 106 | |
| Rifai, 199633 | 260, ages 12-20, AA | Family history of early CHD or hyperlipidemia | Fasting LDL > 110 mg/dL | 10% | NR | 365 | 184 | 37% targeted for screening based on AAP/NCEP recommendations |
| Sanchez Bayle, 199269 | 2,224, ages 2-18, Spain | Parental history of MI | Fasting TC > 200 mg/dL | 7% | 96% | 49 | 140 | |
| 2,224, ages 2-18, Spain | Parental history of MI | Fasting LDL > 135 mg/dL | 9% | 96% | 49 | 101 | ||
| 2,224, ages 2-18, Spain | Parental history of stroke, HTN, diabetes, or hypercholesterolemia (but not MI) | Fasting TC > 200 mg/dL | 14% | 90% | 98 | 129 | ||
| 2,224, ages 2-18, Spain | Parental history of stroke, HTN, diabetes, or hypercholesterolemia (but not MI) | Fasting LDL > 135 mg/dL | 14% | 91% | 98 | 95 | ||
| Shea, 199034 |
108, ages 4-5, Hispanic, Study of Childhood Activity & Nutrition | AAP definition (maternal hypertension, diabetes, obesity, hyperlipidemia or family history of premature CHD or hyperlipidemia) | Fasting TC > 170 mg/dL | 57% | 59% | 493 | 148 | accuracy 58% |
| 108, ages 4-5, Hispanic, Study of Childhood Activity & Nutrition | AHA and NIH Consensus Conference definition (history of hyperlipidemia or premature CHD in the child's parent, aunt, uncle or grandparent) | Fasting TC > 170 mg/dL | 46% | 70% | 352 | 185 | accuracy 62% | |
| 108, ages 4-5, Hispanic, Study of Childhood Activity & Nutrition | NCEP guidelines (history of MI or sudden death in the child's parent, aunt, uncle, or grandparent; CHD prior to age 55). | Fasting TC > 170 mg/dL | 5% | 92% | 74 | 324 | accuracy 62% | |
| Steiner, 199170 | 1,001, ages 12-21 (38% Hispanic, 33.5% W, 15% AA, 11% Asian), Kaiser population | AAP 1998 criteria (known hyperlipidemia in parent or sibling, known MI/angina, current corticosteroid use, juvenile diabetes, hypothyroidism, renal/endocrine/hepatic disease in teenager) | Non-fasting TC > 200 mg/dL, repeated fasting TC if initial test > 200 mg/dL, repeated a 3rd time if more than 30 mg/dL variability between the 1st two measurements |
63% | 60% | 400 | 24 | 1/3 of 1/2 of teenagers with elevated cholesterol levels would have been missed by family history target screening alone |
| Troxler, 199171 | 110 mostly Hispanic senior high school students | Questionnaires completed with parental assistance; family history in parents or grandparents of high cholesterol or CHD age < 55 (AAP) | Fasting TC > 75th percentile (175 mg/dL) | 38% | 79% | 218 | 245 | |
| Wadowski, 199474 | 300 AA, ages 2-14 | Family history of CHD in parent or grandparent at age < 55 | Fasting TC > 215 mg/dL | 59% | 72% | 327 | 23 |
Notes:
a. If not explicitly stated, values are mixed non-fasting/fasting or not reported.
b. Number eligible for screening and number missed were calculated from available data. In some cases, reported data did not allow for these calculations (these indicated with N/A).
Abbreviations:
AA = African American, AAP = American Academy of Pediatrics, AHA = American Heart Association, CHD = Coronary heart disease, CVD = Cardiovascular disease, HTN = Hypertension, LDL = Low-density lipoprotein, LRC = Lipid Research Clinic, MI = Myocardial infarction, N/A = Not applicable, NCEP = National Cholesterol Education Program, NIH = National Institutes of Health, PVD = Peripheral vascular disease, TC = Total cholesterol, W = White.