Total cholesterol screening in teenagers and reassessment ten years later

Background The opportunity to screen, on a large scale, individuals who might be at health risk are limited. Blood donation is a unique opportunity for such screening since volunteers, who identify themselves during donor registration as "well and healthy," can have their mandated infectious disease screening supplemented with tests for markers of disease risk. For those volunteer blood donors who donate regularly, their health risk screening can be monitored for changes over time. Purpose As evidence for cardiovascular disease risk we evaluated changes in total non-fasting serum cholesterol levels in teenage blood donors over a ten-year period of their donation history. Methods We reviewed the total non-fasting serum cholesterol measurements (Aeroset C800) in 17, 18, or 19 year old blood donors in 2015 and compared those results with the total cholesterol levels, in the same individuals, measured at a blood donation ten years later. We chose, as recommended by the National Heart Lung and Blood Institute Expert Panel on Integrated Guidelines for Pediatric Cardiovascular Health and Risk Reduction, a total cholesterol value of <170 mg/dL (<4.3 mmol/L) as acceptable for teenagers, and we chose the AHA/ACC Guidelines on the Management of Blood Cholesterol adult level of <200 mg/dL (<5.1 mmol/L) as normal for the measurement ten years later. Results There were 258 male and 301 female teenagers with donations over ten years. Mean total cholesterol levels at first donation were 153.4 ±28.1 mg/dL (3.97 ± 0.73 mmol/L) in the men and 161.7 ±29.2 mg/dL (4.18 ± 0.75 mmol/L) in women. Ten years later these mean levels were 182.8 ±37.1 mg/dL (4.72 ± 0.95 mmol/L) and 173.3 ±39.8 mg/dL (4.48 ± 1.02 mmol/L) in men and women respectively. Of 67 men with a cholesterol ≥170 mg/dL (≥ 4.3 mmol/L) at presentation, 34 (53.1%) were elevated ten years later. For women, 103 with cholesterol ≥170 mg/dL (≥ 4.3 mmol/L) at presentation, 31 (30.1%) were elevated ten years later. By comparison, 34 of 191 men (17.8%) with a cholesterol <170 mg/dL (< 4.3 mmol/L) at presentation were greater than 200 mg/dL (>5.1 mmol/L) ten years later and 19 of 198 women (9.6%) with a cholesterol <170 mg/dL (< 4.3 mmol/L) at presentation were elevated ten years later. Conclusions Blood donation is an opportunity to measure changes in cardiovascular risk over time. While early screening identifies teenagers with elevated total cholesterol levels which may persist over ten years, an acceptable early value does not imply absence of developing elevated values in the long term.