Child-parent screening for familial hypercholesterolaemia: screening strategy based on a meta-analysis.

BMJ. 2007 Sep 22;335(7620):599. Epub 2007 Sep 13.
Comment in: BMJ. 2007 Oct 6;335(7622):683.
BMJ. 2007 Oct 6;335(7622):683.
BMJ. 2007 Sep 22;335(7620):573-4.
Wald DS, Bestwick JP, Wald NJ.
OBJECTIVE: To develop a population screening strategy for familial hypercholesterolaemia.
DESIGN: Meta-analysis of published data on total and low density lipoprotein (LDL) cholesterol in people with and without familial hypercholesterolaemia according to age. Thirteen studies reporting on 1907 cases and 16 221 controls were used in the analysis. Included studies had at least 10 cases and controls with data on the distribution of cholesterol in affected and unaffected individuals.
MAIN OUTCOME MEASURES: Detection rates (sensitivity) for specified false positive rates (0.1%, 0.5%, and 1%) in newborns and in age groups1-9, 10-19, 20-39, 40-59, and > or =60 years.
RESULTS: Serum cholesterol concentration discriminated best between people with and without familial hypercholesterolaemia at ages 1-9, when the detection rates with total cholesterol were 88%, 94%, and 96% for false positive rates of 0.1%, 0.5%, and1%. The results were similar with LDL cholesterol. Screening newborns was muchless effective. Once an affected child is identified, measurement of cholesterol would detect about 96% of parents with the disorder, using the simple rule thatthe parent with the higher serum cholesterol concentration is the affected parent.
CONCLUSIONS: The proposed strategy of screening children and parents for familial hypercholesterolaemia could have considerable impact in preventing the medical consequences of this disorder in two generations simultaneously.