Study Reveals Cost-Effective Strategies for Cholesterol Screening in Youth

A new study conducted by researchers at Columbia University and Harvard University has explored the feasibility of screening children for familial hypercholesterolemia (FH), a genetic condition leading to dangerously high cholesterol levels. The research highlights the potential to prevent premature heart attacks and strokes among young individuals, but it also points to the high costs currently associated with such screening programs.

In the United States, approximately **1 in 250** people possess a genetic variant that results in FH, which can significantly elevate the risk of cardiovascular events as early as their 30s or 40s if left untreated. Alarmingly, only about **10%** of those affected are aware of their condition, leaving millions at risk. The study, titled “Familial Hypercholesterolemia Screening in Early Childhood and Early Adulthood: A Cost-Effectiveness Study,” was published on **November 9, 2025**, in the journal JAMA.

Key Findings on Screening Strategies

The researchers employed a modeling approach to evaluate various two-stage screening strategies. These strategies involve first measuring cholesterol levels among children, followed by genetic testing for FH in those who exhibit elevated cholesterol. They assessed the cost-effectiveness of screening at age **10** and again at age **18**, considering the long-term benefits of early detection and management of high cholesterol.

According to Andrew Moran, an associate professor of medicine at Columbia University Vagelos College of Physicians and Surgeons and a senior author of the study, “Early recognition and management of high cholesterol, even in childhood, can prevent or delay heart attacks, strokes, and maybe even dementia later in life.” He emphasized the importance of finding a cost-effective method for early screening for FH, especially for those with severely elevated cholesterol levels without a known genetic cause.

The research identified that **one in five** adolescents exhibits some abnormality in their lipid profiles. While the American Academy of Pediatrics and the American Heart Association recommend that all children undergo cholesterol screening between the ages of **9** and **11**, less than **20%** of children currently receive this testing.

Evaluating Cost-Effectiveness

The study’s findings suggest that while screening for FH specifically is not currently cost-effective due to high upfront costs, a more comprehensive approach could change this dynamic. If cholesterol screening leads to more intensive management and lifestyle changes for all children and young adults with high cholesterol levels—regardless of genetic results—it could become a viable option.

Moran noted, “Though FH is among the most common and severe genetic disorders, it’s still relatively rare. Because of the high upfront costs of screening millions to find a relatively small number of people with FH genes, our modeling found that none of the combined cholesterol plus genetic screening strategies were cost-effective compared to usual care.”

Further exploration into the potential for newborn screening may offer a solution. Recent studies suggest that combining FH screening with established screening protocols for newborns could yield more effective results at scale. The research teams at Columbia and Harvard are collaborating with other investigators to refine screening methods for infants.

Another advantage of implementing genetic testing for FH in children is the potential for “cascade screening,” where family members of identified individuals can also be tested and treated, thereby addressing hidden cases of FH within families.

Moran concluded, “We haven’t landed on the best way to screen early for FH yet, but with our modeling, we’re leveraging the best evidence and efficient computer modeling methods to arrive at the most promising approaches to test in real clinical trials of screening.”

This study underscores the importance of addressing high cholesterol in youth and presents a pathway towards more comprehensive screening programs that could ultimately save lives.