MANITOULIN—In a new position statement released last month, the Canadian Paediatric Society is urging something that may unsettle parents and policymakers alike: test children — all children — for cholesterol, starting as young as two years old.
The reasoning is as stark as it is simple. Atherosclerosis — the slow, silent buildup of plaque in the arteries — does not wait for adulthood. It begins in childhood, laying down its first layers long before symptoms ever appear, and setting the stage for heart disease and stroke decades later.
Dr. Michael Khoury, a pediatric cardiologist and the statement’s lead author, points to a hidden population moving through the system undetected. Roughly one in 300 Canadians lives with familial hypercholesterolemia (FH), a genetic condition that drives dangerously high cholesterol levels from an early age.
Without routine screening, he says, as many as 95 percent of those children are missed.
They look healthy. They are healthy — until, suddenly, they’re not.
FH is not the product of poor diet or inactivity, though those factors matter. It is written into the body at the molecular level — a mutation that prevents the liver from clearing low-density lipoprotein (LDL), often called “bad” cholesterol. The result is a quiet accumulation in the bloodstream, feeding the plaques that narrow arteries and restrict blood flow to the heart and brain.
A simple blood test could change that trajectory.
Caught early, children can begin treatment — first through diet and physical activity and, if needed, medication. The aim is not just management, but prevention: stopping cardiovascular disease before it ever has the chance to take root.
At Stollery Children’s Hospital and the University of Alberta, where Dr. Khoury works in preventive cardiology, long-term data suggests that early intervention can dramatically reduce the risk of heart attack and stroke later in life. Follow children over 20 years, he says, and their cardiovascular risk can be brought back in line — as if the condition had never been there at all.
But the path upstream, toward prevention, is rarely smooth.
Dr. Alykhan Abdulla, a family physician in eastern Ontario, agrees with the principle. Medicine, he argues, must move beyond reacting to illness and begin intercepting it earlier.
Still, he raises a harder question — one less about science, and more about capacity.
What happens when thousands of children suddenly require blood tests? Follow-ups? Dietitians, fitness supports, long-term monitoring?
An already strained health-care system, he warns, may buckle under the weight of doing the right thing.
And yet, he adds, these are precisely the kinds of investments that matter — the slow, preventative work that rarely makes headlines but reshapes futures.
For families living with FH, the stakes are not theoretical.
Mike Heathcote learned he had high cholesterol as a child, but it wasn’t until later that the genetic cause was identified. When he had his own children tested, both were found to have the same condition — despite living what most would consider healthy, active lives.
You wouldn’t know, he says, unless you looked.
Early diagnosis meant early treatment. Medication, monitoring, a different path forward.
For his daughter, now a teenager, the intervention feels almost deceptively simple — a brief needle, a moment’s discomfort.
A small puncture, against the long arc of a life.
The new guidance recommends screening between the ages of two and 10, offering multiple opportunities for primary-care providers to catch the condition early, even if medication typically begins closer to age eight. In many cases, treatment will continue for life.
South of the border, the American Academy of Pediatrics already recommends routine cholesterol screening between ages nine and 11, with earlier testing for children at higher risk.
Until now, Canada has had no clear, unified direction.
What this new statement offers is not just a guideline, but a shift in posture — from crisis response to quiet prevention, from downstream rescue to upstream care.
