Clinical importance and context
When assessing an apparently healthy child or adolescent, evaluation of the lipid profile may not intuitively appear to be a clinical priority. However, evidence shows that atherosclerosis begins early in life and that dyslipidaemia in childhood and adolescence is an important determinant of future cardiovascular risk. Early identification therefore represents not only a diagnostic step, but above all an opportunity for preventive intervention throughout the life course.
Asymptomatic nature and rationale for screening
Paediatric dyslipidaemia is asymptomatic in most cases. There are no early manifestations that would spontaneously raise clinical suspicion, so the approach relies on defined screening criteria. This strategy helps identify children who are more likely to have clinically relevant lipid abnormalities and prevents potentially serious conditions, such as familial hypercholesterolaemia, from remaining undiagnosed for years.
Universal and selective screening
The distinction between universal screening and selective screening is a central element of the approach. Universal screening at school age aims to ensure equity and broad coverage, allowing abnormalities to be detected even in the absence of known risk factors. Selective screening, in turn, is based on identifying clinical or family factors that significantly increase the likelihood of dyslipidaemia, such as a family history of premature cardiovascular disease, overweight, diabetes, hypertension, kidney disease or exposure to certain medications.
Interpretation of the lipid profile
Once the lipid profile has been obtained, interpretation should take into account paediatric age-specific reference values. Unlike in adults, normal and risk thresholds are different and reflect physiological changes in lipid metabolism during growth. Classification into normal, borderline or high values allows the level of risk to be established objectively and guides subsequent management.
Approach to borderline values
When borderline abnormalities are identified, intervention focuses predominantly on lifestyle. Dietary modification, promotion of physical activity and reduction of sedentary behaviour form the basis of the initial approach. At this stage, assessment also has an important educational role, involving the child and family in understanding cardiovascular risk and adopting healthy long-term behaviours.
Diagnostic confirmation in the presence of high values
When values are clearly elevated, the focus shifts to diagnostic confirmation and assessment of whether the dyslipidaemia persists. Biological variability and transient factors may influence laboratory results, so repeat testing under standardised conditions is essential to validate the diagnosis. This step is intended to confirm the abnormality and not to assess the effect of therapeutic interventions.
Suspected familial hypercholesterolaemia
Whenever lipid elevation is marked, particularly when associated with a suggestive family history, the possibility of familial hypercholesterolaemia should be considered. This genetic condition is characterised by persistently elevated LDL levels from childhood and is associated with a substantially increased risk of premature cardiovascular disease, making timely recognition essential.
Preventive and longitudinal perspective
Throughout the process, the approach should remain centred on a preventive and longitudinal perspective. Paediatric dyslipidaemia should not be regarded as an isolated problem, but rather as a risk marker within the broader context of cardiovascular health, integrating nutritional assessment, blood pressure and lifestyle habits.
Summary of the approach
In summary, this approach follows a logical sequence: recognising the importance of early prevention, identifying who should be assessed, interpreting the results correctly and adapting intervention to the level of risk. This structure transforms an often silent finding into a valuable opportunity for lifelong cardiovascular prevention.
