Screen all kids between 2 and 10 for high cholesterol, pediatric society recommends

Here’s why family doctors and pediatricians in Canada are being urged to screen children for cholesterol. Scott Hurst reports.

TORONTO — The Canadian Paediatric Society is recommending cholesterol screening for all kids between two and 10 years old.

The position statement released Friday says atherosclerosis — or plaque buildup in the arteries, including cholesterol — starts in childhood and is a key driver of heart disease and stroke.

Lead author and pediatric cardiologist Dr. Michael Khoury says about one in 300 people have high cholesterol caused by a genetic condition passed down through families.

He says universal screening with a blood test will allow doctors to identify the condition early and begin treatment, including diet and physical activity.

Khoury says those lifestyle changes aren’t enough for many kids with severely high cholesterol and treatment with medications can begin at age eight.

He says treating the condition in childhood can prevent cardiovascular illness from appearing in adulthood.

“We’re working to treat the 20-, 30- and 40-year-old version of that child,” said Khoury, who specializes in preventive cardiology at the Stollery Children’s Hospital and the University of Alberta in Edmonton.

Without universal screening, doctors are missing about 95 per cent of children who have the genetic condition, called familial hypercholesterolemia or FH, Khoury said.

Long-term safety data has shown that statin medications commonly used to treat high cholesterol in adults, such as Lipitor and Crestor, can be given to children age eight and above, often in lower doses, he said.

“The benefits of using these medications far outweigh the risks,” Khoury said.

“When you follow these children up 20 years later, you can normalize their cardiovascular risk and if we treat them adequately, remove the likelihood that they’re at a substantially increased risk for having an early heart attack or stroke when they’re in the prime of their lives in (their) 30s and 40s.”

The American Academy of Pediatrics currently recommends all children have cholesterol tests between nine and 11 years of age.

But pediatricians in the U.S. may recommend screening as early as age two if they have significant risk factors, including high blood pressure, obesity or diabetes, a known family history of FH, or a parent or grandparent with heart or cholesterol problems, the American organization said.

Khoury said family doctors and pediatricians in Canada haven’t had a clear set of recommendations until now.

The guidance to do cholesterol screening between two and 10 years of age is meant to give primary care physicians as many chances as possible to do the blood test, even though treatment with medication likely wouldn’t begin until age eight.

“My approach personally to this is that we should be opportunistic. And so that means that if a child is going for blood work for another reason and a physician notes that they’ve never had a (cholesterol) screening test done before, we should tack it on,” Khoury said.

If a child has been seeing their doctor regularly as a baby and toddler but the physician doesn’t expect to see them as often during their school-age years, the doctor can decide to do the test then, he said.

If a child tests positive for FH, they are often referred to a pediatric lipid specialist like Khoury to monitor the levels of low-density lipoprotein cholesterol — often called “bad” cholesterol — and begin treatment as needed.

Familial hypercholesterolemia is most commonly caused by a mutation in the LDL receptor on the liver. The mutation prevents the LDL cholesterol from getting into the liver, so it accumulates in the blood, Khoury said.

That also triggers the liver to detect a “low cholesterol environment” and ramp up cholesterol production.

LDL cholesterol, along with fat and other substances, is a major component of plaque that builds up in the arteries and limits blood flow to the heart and brain.

This report by The Canadian Press was first published Feb. 27, 2026.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

Nicole Ireland, The Canadian Press