1. Unique in Slovakia for 17 years
Universal screening for hypercholesterolemia in children at 11- and 17 years of age:
Unique in Slovakia for 17 years
Simurka P. *, Schusterova I., Tohatyova A., , Rosipal S., Fajdalova M., Fozoova A., Dubcek A**.
Department of Paediatrics and Adolescent, Trencin*,
Department of Paediatrics and Adolescent Medcine, Slovakia Faculty of Medicine, P. J. Safárik University in Kosice; Slovakia Faculty Children Hospital, Bratislava**

2. PRIMARY PREVENTION OF CARDIOVASCULAR DISEASES IN CHILDHOOD
Atherosclerosis begins in childhood
Bogalusa Heart Study
Framingham Study
Muscatine Study
PDAY Study (The Pathological Determinants of Atherosclerosis in Youth)
RFs of disease progression are the same as in adults
The identification of individuals with atherosclerotic lesions by means of clinical signs is not possible

3. Possibilities to identification of children with increased CV risk
Biochemical parameters (cholesterol, lipids)
Anthropometric measurements
The blood pressure
In American Heart Association → National Cholesterol Educational Program (NCEP)
" It is recommended to do selective screening of cholesterol in all children with RFs of premature atherosclerosis "

4. AHA: Selective screening for cholesterol in all children...
The main disadvantage of selective cholesterol screening: up to 50% of children with increased CV risk are missing
Tu by som nedala názov práce , ale niečo , že V našej práci sme sa pokúsili o vytvorenie systému celoplošného skríningu v SR a následnej intervencii v cieovej skupine detí s RF ATS
SOLUTION ? → universal screening (in all children)

5. National Slovak Project of Ministry of Health Pilot study: Universal Cholesterol Screening in 11. and 17. years children and adolescents
SLOVAKIA REGIONS
Slovak Regions

6. National Slovak Project of Ministry of Health Pilot study: Universal Cholesterol Screening
Project Cooperation
practitioners for children
and adolescent
district specialists for pediatrics
regional specialists for pediatrics
regional hospitals national health
institutions
workplaces of clinical biochemistry

7. National Slovak Project of Ministry of Health Pilot study: Universal Cholesterol Screening organization of project realization

8. National Slovak
Project of Ministry of Health Pilot study: Universal Cholesterol Screening
The study population
11y
17y
Both
Boys
6965
4155
11120
Girls
6800
4133
10933
13765
8288
22053

9. 11y
17y
Both
Bratislava
1242
821
2063
Trnava
1912
1005
2917
Trencin
2150
1108
3258
Nintra
1371
988
2359
Zilina
1697
1198
2895
Banska Bystrica
1976
1052
3028
Presov
1720
1112
2832
Kosice
1698
1006
2704
National Slovak Project of Ministry of Health Pilot study: Universal Cholesterol Screening
Zilina
Presov
Trencin
Banska Bystrica
Kosice
Trnava
Nitra
Bratislava

10. National Slovak Project of Ministry of Health Pilot study: Universal Cholesterol Screening
Lipid profile classification for Slovak children and teenagers (screening values)
Category
Acceptable
Border
Increased
 Percentiles
< 75.perc.
perc.
≥ 95.perc.
Total CHOL mmol/l
2.85 – 4.10
4.10 – 4.85
˃ 4.85
LDL CHOL mmol/l
1.80 – 2.60
2.60 – 3.25
˃ 3.25
HDL CHOL mmol/l
,55
*1.25 – 1.75
1.55 – 1.85
*1.75 – 2.04
˃1.85
˃ 2.04
* girls in postpubertal age
Non HDL CHOL mmol/l
do 2.85
2.85 – 3.50
˃ 3.50
Triacylglycerol mmol/l
0.42 – 1.15
,50
˃ 1.50
Apolipoproteín B g/l
0.60 – 0.85
0.85 – 1.05
˃ 1.05

11. National Slovak Project of Ministry of Health Pilot study: Universal Cholesterol Screening
11 years
Total cholesterol
(in mmol/l)
GIRLS
BOYS
Number
6729
6903
Average
4.38
4.36 SD
0.74
0.71
Median
4.31
Minimum
1.73
1.77
Maximum
11.13
9.6

12. National Slovak Project of Ministry of Health Pilot study: Universal Cholesterol Screening
17 years
Total cholesterol
(in mmol/l)
GIRLS
BOYS
Number
4109
4126
Average
4.322
3.88 SD
0.77
0.70
Median
4.15
3.81
Minimum
1.99
2.00
Maximum
11.07
8.77

13. average: screening 5.26 rescreening 4.98
National Slovak Project of Ministry of Health Pilot study: Universal Cholesterol Screening
The relationship between total cholesterol in screening and rescreening (in mmol/l)
average: screening rescreening 4.98
Average difference: SD 0.59
couple t-test:
p < N = 1696
rescreening = x screening
r = 0.38

14. Total cholesterol (TCH) screening
National Slovak Project of Ministry of Health Pilot study: Universal Cholesterol Screening
Total cholesterol (TCH) screening
Risk TCH  4.85 mmol/l
Non-risk TCH < 4.85 mmol/l
Screening
4.8 % TCH mmol/l
Re-screening
1.4 % TCH 4.85 – 5.4 mmol/l
+ positive FH
10.6 %
positive
3.8 % TCH mmol/l
79.88 %
non-risk
20.12 %
risk
0.5 % TCH > 6.5 mmol/l
9.6 %
negat.

15. Universal screening for hypercholesterolemia in children at 11- and 17 years of age in SLOVAKIA
Applicate to our conditions
Creation of wide cholesterol screening system in Slovakia
Subsequent intervention in the target group - children with increased, very high CV risk of atherosclerosis and premature CV disease
Governed by the law in y. 2004

16. Universal screening for hypercholesterolemia in children at 11- and 17 years of age Management in praxis
1. screening → 11 and 17 years children in preventive examination
2. rescreening → total cholesterol ≥ 4.85 mmol/l + HDL- cholesterol, LDL- cholesterol, triglycerides
3. positive rescreening
Pediatricians: TCH 4.85 – 5.4 mmol/l + negative FH
Specialists (cardiologists and endocrinologists):
4.85 – 5.4 mmol/l + positive FH
TCH ≥ 5.4 mmol/l and < 6.5 mmol/l
Specialized centers (3 in Slovakia):
TCH ≥ 6.5 mmol/l and ≤ 2.85 mmol/l

17. Universal screening for hypercholesterolemia
in children at 11- and 17 years of age
YEAR: 2015
Number of children
Overall 11- and 17 years
Positive screening
Positive rescreening
Pediatricians
Specialists
(cardiologists and endocrinologists)
Specialized centers (3 centers)

18. National Slovak Project of Ministry of Health Pilot study: Universal Cholesterol Screening Total cholesterol TRENDS
p<0.001
p<0.01
Šimurka P.: Kongres Slovenskej pediatrickej spol. ,B. Bystrica, 2011

19. SLOVAKIA
Slovakia is the first country in the world were national cholesterol screening in childhood is done
Screening is supported by the Ministry of Health Slovak Republic and governed by the law in y. 2004
Screening is supplied by legislation for all children and performed by pediatricians in primary health care
This screening is supported by health insurance beyond preventive examination
After 2004 was in Slovakia cholesterol screening at 11 and 17 years old children examined more than 1 million children

20. Thank you for your attention!