Summary
Hypercholesterolemia has an established link with a risk of cardiac events and there has been a push to screen high risk population for early intervention in an effort to reduce the incidence of heart attacks and strokes, for example. However to suggest any benefit from screening babies is to misunderstand the science and is immediately suspect in my view. Such a measure if adopted would increase healthcare costs and cause undue worry for parents, with no corresponding ability to mitigate the risk they are now told exists.
Analysis
First this is a meta-analysis of several studies and does not carry the same weight as a well constructed scientific study. There has been an ever increasing number of neonatal screening tests based on the fact that there is some corresponding identified intervention that can be done. Whether it's for thyroid disease, PKU, sickle cell or any other neonatal screen; the information is always used to do something useful and to mitigate any likely sequelae.
In this case, testing babies at 15 months would at best indicate a familial tendency for hypercholesterolemia. The pattern of inheritance is autosomal recessive, so both parents would then have to be tested and the one with the high cholesterol (presuming there is one) would be the "culprit". What then? If the concern is high cholesterol, why not screen the parents directly rather than use the child as a surrogate? What treatment would the child undergo? There are no studies I could find in which children younger than 13 were routinely place don statins. As for diet; well ALL kids should be taught to have healthy diet anyway.
This might be case of an obsession with hypercholesterolemia gone crazy. I also wonder if the pharmaceutical companies had something to do with this study. The authors' suggestion is that blood be taken for cholesterol testing at the 15 month mark while the baby is being immunized. I was not surprised that the principal author, Dr Wald has filed a patent for device that combines medication injection with blood sampling. But I am sure he has no vested interest in pushing this cholesterol testing idea!
More work needs to be done in standardizing cholesterol testing woldwide and tweaking the predictive value of test results. Variation in tests results result from preanalytical variables, incidence of high cholesterol in the population tested and a host of other things that make this practice less valuable and clearcut as suggested. We certainly welcome any credible way of how to identify high risk groups early on, in order to intervene meaningfully. This study does not fit that definition.
