Lipid Screening for Cardiovascular Risk in Youth: A Narrative Review of Current Guidelines and Potential Use of Nonfasting Measures

<h2>Abstract</h2> Early identification of dyslipidemia in children and youth allows for the prevention of cardiovascular diseases (CVD). Emerging evidence in adults suggests that nonfasting remnant cholesterol (RC) is a significant independent risk factor for CVD. Understanding the applicability of nonfasting RC in youth and children may provide greater options for routine and early identification of CVD risk. The purpose of this review is to provide an overview of guidelines for assessing dyslipidemia in practice and to explore whether nonfasting lipid biomarkers and/or RC have been incorporated for children and youth. The Medline database was used to identify clinical practice guidelines published between 2011 and August 2025 in English for children and/or youth aged 2-20 years. Of an initial 2537 citations, 41 met the inclusion criteria for data extraction. Although there is controversy regarding assessing fasting or nonfasting biomarkers in youth, definitions of normal ranges of lipoproteins were less controversial and are typically defined based on the National Heart, Lung, and Blood Institute recommendations. Most guidelines recommend measuring fasting lipid biomarkers (especially low-density lipoprotein cholesterol) in youth. In contrast, a select number of guidelines and statements recommend assessing nonfasting non–high-density lipoprotein cholesterol as the priority. Currently, no guidelines discuss measuring RC in youth. Evidence suggests that nonfasting non–high-density lipoprotein cholesterol is a reliable, practical biomarker for lipid screening in children and youth; however, most guidelines still suggest fasting measurement of low-density lipoprotein cholesterol. We note that nonfasting RC is an important knowledge gap not addressed in the current guidelines, and increasing awareness of nonfasting RC may be valuable.