Which scenario does not meet the criteria for selective screening for hyperlipidemia?

Which scenario does not meet the criteria for selective screening for hyperlipidemia?

• A. A 16-year-old adopted adolescent who smokes with no known family history
• B. An 8-year-old child with a small restrictive ventricular septal defect
• C. A 10-year-old child whose father had a balloon angioplasty at age 49 years
• D. A 12-year-old child with a BMI of 28

Answer: (B)

Selective screening for hyperlipidemia in children looks for risk factors that raise the likelihood of abnormal lipids and premature cardiovascular disease. Key flags include a first-degree family history of premature ASCVD, overweight or obesity, and smoking or diabetes. An isolated congenital heart defect by itself does not raise lipid risk, so it does not automatically justify lipid screening in the absence of other risk factors. In the scenarios described, smoking in a teenager is a risk factor that supports screening; a father with premature ASCVD in adulthood is a strong family history trigger for screening; and a child with BMI 28 is overweight and at higher risk for dyslipidemia, warranting screening. The 8-year-old with a small restrictive ventricular septal defect lacks a recognized lipid-risk factor from that finding alone, so this scenario does not meet the criteria for selective screening.

Selective screening for hyperlipidemia in children looks for risk factors that raise the likelihood of abnormal lipids and premature cardiovascular disease. Key flags include a first-degree family history of premature ASCVD, overweight or obesity, and smoking or diabetes. An isolated congenital heart defect by itself does not raise lipid risk, so it does not automatically justify lipid screening in the absence of other risk factors. In the scenarios described, smoking in a teenager is a risk factor that supports screening; a father with premature ASCVD in adulthood is a strong family history trigger for screening; and a child with BMI 28 is overweight and at higher risk for dyslipidemia, warranting screening. The 8-year-old with a small restrictive ventricular septal defect lacks a recognized lipid-risk factor from that finding alone, so this scenario does not meet the criteria for selective screening.