Lipid profiles in German school children: Interim results from Hand aufs Herz Study

Introduction Cardiovascular diseases have been the leading cause of death in Germany for several years and cause substantial expenses on the healthcare system. Certain cardiovascular risk factors are already present in early years of life, nevertheless preventive cardiovascular screening of children and adolescents is currently not implemented. Purpose This study investigates specific lipid biomarkers in children and adolescents as potential early indicators of high cardiovascular risk, with the aim of improving early detection and intervention strategies to reduce future CVD burden. Methods We performed a prospective study with a cardiovascular screening of 1,526 children and young adults in German schools. (8 – 19 years of age) The screening included ECG, echocardiography, clinical exam, biometric measurements, a thorough questionnaire regarding lifestyle, family history and fitness assessment. Additionally, a voluntary blood draw including lipid profile (total cholesterol, low density cholesterol, high density cholesterol, triglycerides) and lipoprotein(a) was offered voluntarily and 387 students participated. (age-specific cut off levels were used for cholesterol and triglycerides and >200 in non-fasting state; Lipoprotein(a) cut off > 75nmol/l.) We also compared the lipid profile between fasting and non- fasting children. Results 8,3% of the pupils showed a disturbance in the lipid profile. (LDL, HDL, total cholesterol and triglycerides) Lipoprotein(a) was above normal in 17.3 % of the students. Our comparison was between fasting and non-fasting pupils. Overall, we had 63 children who participated in the blood draw in a fasting state and 324 in a non-fasting state. There was no difference of the cholesterol in fasting 154.22± 32.36 mg/dl and non-fasting state 154.01± 28.71 mg/dl (p =0,96), HDL 57.22± 11.89 mg/dl fasting and 56,95± 12.77 mg/dl in non-fasting state. (p=0.87) and LDL 87.4± 23.77 mg/dl in fasting and 85.15 mg/dl± 23.66 in non-fasting state. (p=0.49) Triglycerides however were significantly lower in fasting 73.84± 33.27 mg/dl compared to non-fasting state 88.52± 51.08 mg/dl (p=0.004). Conclusion Approximately one in ten pupils had abnormal lipid profile results. The obtained values from the blood samples are part of well-established predictors for evaluating the individual cardiovascular risk profile. Despite it being an important cardiovascular risk factor even at a young age, there is currently no national screening program for the pediatric population in Germany. However, a blood draw at the J2, a voluntary adolescent health examination, including cholesterol is recommended. We found blood cholesterol can be determined in a non-fasting state without a significant difference in results. As metabolic and cardiovascular diseases increase, preventive health programs with blood testing for specific markers can enable early detection and intervention, helping to reduce long-term burden of cardiovascular disease.