Family History of Coronary Artery Disease and Cholesterol: Screening Children in a Disadvantaged Inner-City Population

Abstract

Little information relating to cholesterol levels and screening for hypercholesterolemia in inner-city children exists. For this study, given the disrupted family backgrounds of many of our patients and the unreliability of family histories, our hypothesis was that in comparison with other samples, family history of coronary heart disease would be a poor screening tool for the identification of children with elevations in total serum cholesterol (TSC). During 15 months, more than 400 pediatric outpatients, 2 through 14 years old, were screened for a family history of atherosclerotic disease. These children were attending a clinic serving a disadvantaged black and Hispanic population at Kings County Hospital Center. Nonfasting TSC levels were measured in 300 children. Positive risk for coronary heart disease was determined by the presence of a family history of coronary heart disease (defined as angina, stroke, or myocardial infarction in any parent or grandparent) at less than 55 years age. The mean TSC level was 4.27 mmol/L SD +/- 0.85) (165.0 mg/dL [SD +/- 32.8]). The 29.4% of this population with a history suggestive of high risk for hypercholesterolemia had a mean TSC of 4.48 mmol/L (SD +/- 0.971) (173.2 mg/dL [SD +/- 37.5]), and those with no risk history had a mean TSC of 4.18 mmol/L (SD +/- 0.750) (161.4 mg/dL [SD +/- 29.9]) (P < .005). Use of family history of coronary artery disease as a screening tool had a sensitivity of 39.3%, a specificity of 74.5%, and a positive predictive value of 39.8% for detection of moderate hypercholesterolemia (TSC > or = 4.66 mmol/L [180 mg/dL]). This population's mean TSC level did not differ (P > .10) from those obtained in multiple large studies of average North American populations, and the predictive value and sensitivity of family history as a screening tool was comparable, although the prevalence of a positive family history was greater. The findings may be due to a greater prevalence of coronary artery disease at a young age in these families. In this population, a positive risk history is an important indicator for further evaluation of these children.