Dr. Labos: Should your two-year-old be screened for high cholesterol?

0:00Jay, for our in for Joanne, Vrakis, she'll be back with you next weekend. Most parents have never thought about their toddler's cholesterol. So we worry about it as we get older, but obviously not for your toddler. So should we be checking in toddlers, according to the Canadian Pediatric Society, they just release new recommendations calling for cholesterol screening in all children between the ages of two and ten. Now the concern seems to be a genetic condition here to break it down is Dr. Christopher Labos. Doc, welcome. Dude, I think you called me an hour early, I'm going to go back to bed, okay? He's mad at me. You have to blame the farmers for this, Doc. Yeah, it's not my fault, I swear. Listen, I don't know where you got this idea that the clock's just supposed to change. The earth is flat. It's the same time everywhere. I do not just absolute nonsense. I do not control the space time continuum, my friend. I wish I did because you and I'd still be sleeping right now, believe me.

1:04So tell us more about this. Listen, I'm 49 years old. I'm not even worrying about my cholesterol right now, although I probably should be. But most parents, they're not thinking about their toddler's cholesterol. Why is the society or expert saying we need to start screening as young as age two? Because we're not diagnosing a lot of people with high cholesterol. So if you're an adult, the guidelines are you should get a screening at least once after age 40, and then if it's normal, then you can do it sort of in five-year increments. Okay. But for children, most people don't think about high cholesterol. And that's an issue because we tend to think that cholesterol is diet and as we get older or diet gets poor, cholesterol builds up, but the reality is for a lot of us, our cholesterol is genetically mediated. And of course, the thing about genetics is that it starts from childhood. So there's a lot of children out there walking around with high cholesterol that just never gets picked up until the enter adulthood. And if a child has genetically high levels of cholesterol, you should, number one, try

2:07to get into change or diet a little bit, whatever benefit that might have. But number two, you probably need to treat them if it's severe and not responding to dietary therapy because if you don't treat them, that cholesterol is going to slowly build up. And when you hear people about having a heart attack sort of at a young age, like in their 40s and 50s, which is young to have a heart attack these days, it's usually because they had some untreated risk factor that went undiagnosed for many, many years. And genetic cholesterol is one of them because it's actually more common than we realize. And this is an inherited trait? Yeah, so there's multiple different genetic diseases that cause high cholesterol. But by far, the most common is one called hemoglobul hypercholestrolemia. That's a problem with the cholesterol receptor. And it affects about one in 300 people across Canada, but in Quebec, it affects about one in 90 people. So it's much more common here. Why is that? Why would that be?

3:08Ah, so that caused by something called the founder effect. So if you go back in time, when new France was first settled by the French colonists, most of them came from northwestern France. And over the course of the first 150 years, only a very small number of people from France came to what would become Quebec. There's only about 8,000 to 10,000 settlers. And so those people, because they came from the same region in France, they had a particular mutation. And because over the years, generation after generation, they kept having babies, that mutation just became more common, because, and this is true, most people in Quebec would really have a French Canadian ancestry, they can trace their lineage back to those original settlers. So because that initial founding population has been here and have just been expanding, that rare mutation just became much more common here in Quebec. Oh, that is fascinating. So you explain what it is and how what happens if it goes undetected, undetected.

4:10What are the medications that are used for this? This is a young child we're talking about, I guess, right? So that would raise some eyebrows for some parents, using medication to kind of, kind of, I guess, temper the cholesterol condition. Yeah, but you know what? It actually has been studied. So even statins that, you know, everybody have become like a lightning rod on the internet, they have been tried and studied in children, and just, I think in 2019, a couple of years ago, where I guess more than a couple of years ago now, in 2019, there was a very large paper published where they actually looked at the 20-year follow-up. So children have been given statins, people have looked at what the long-term side effects are, and there aren't. And when you treat children with FH, familiar, hypercholestrolemia, they have less heart attacks when they enter adulthood. So this has been studied. This has been proven. And so the same medications you use for adults, you would use it for children. You would obviously only want to reserve it for the more severe cases because you don't want to start people on medication if you don't have to, but if a child has very hypercholestrol

5:15and is not responding to lifestyle factors, yeah, you should probably treat them because you're preventing a heart attack and a stroke 20 years down the road. So from a healthcare system perspective, you know, having a strain healthcare system, this could probably, is it either beneficial or could it lead to a little bit more backup because the parents are going to start screening for this cholesterol in their kids? It shouldn't cause that much of a backup because it's really just a set of cholesterol tests that you could put in part of your race, you know, basic blood tests. So at some point during your childhood, and this is what the recommendations are, sometimes between the ages of two and ten, if you're going to get blood tests for other stuff, anyways, might as well check cholesterol. And then if you spot high cholesterol, then you refer them or you start working them up. But the point is just to have a universal screening, get it tested once, and if it's fine as a kid, test it one more, sort of like a teenage or young adult, and then once again once you start, you know, the slow decline of old age after age 40.

6:16Yes, yes, I'm feeling it now. So it's a basic blood test, is that it for the kids? Yeah, you basically just check in cholesterol levels, and then if that thing, then you could do more complex genetic testing if you want to do family screening and stuff like that. Great great stuff, really, really interesting stuff, especially about the historic context of Quebec and wire cholesterol is a little bit higher, fascinating stuff, I appreciate that doc. Introducing Brian Adams Radio, an eye heart radio, tested by Brian Adams himself. Join me for an insight of look on a wild ride to 40 years of global rock and roll. Brian Adams Radio, now available on the free eye heart radio app, or ask your smart speaker to play Brian Adams Radio, an eye heart radio. I was ready to rock.