New Data Offer Benchmark For Assessing Changes in Lipid Screening Practice Patterns
Guidelines sponsored by National Heart, Lung, and Blood Institute and endorsed by the American Academy of Pediatrics in 2011 recommended universal screening for dyslipidemia in children ages 9 to 11 and again at 17 to 21 years old. Since then, however, critics have expressed concerns about long-term costs, lack of outcome data, the unknown safety of lifelong statin treatment and the low predictive value of childhood lipid screening.
Recognizing these concerns, a new study published in Circulation: Cardiovascular Quality Outcomes provides a closer look at lipid screening in children and adolescents in community practice prior to the 2011 recommendations. Specifically, the study looked at the frequency and results of lipid testing in 301,080 children and adolescents ages three to 19 enrolled in three large U.S. health systems in 2007 to 2010.
“Given the controversy surrounding the varying expert recommendations, additional data on pre-guideline pediatric lipid screening practices are needed to inform assessment of the effect of the new recommendations on identification of clinically significant dyslipidemia in children and adolescents,” the authors note.
Overall, the study found that lipid screening across the three health systems was uncommon in 9- to 11-year-old children (8.9 percent) and was performed in less than 25 percent of 17- to 19-year-old adolescents, both of the age groups targeted by the 2011 guideline. According to the authors, the proportion of children screened increased with age and body mass index, although a minority of overweight and obese children were screened across all age groups. Other factors, including sex, race, ethnicity and blood pressure were weakly associated with testing. Also of note, while abnormal lipid values were more likely to be found in children with elevated body mass index, among children with body mass index <85th percentile abnormal lipid levels were found in 6.7 percent for total cholesterol, 12.6 percent for high-density lipoprotein-cholesterol, and 6.9 percent for non–high-density lipoprotein-cholesterol.
Moving forward, the authors suggest that these data “provide a useful benchmark for assessing change in practice patterns in large heath systems following the new recommendations for pediatric lipid screening and subsequent management.” They note that, given these results, universal pediatric lipid screening will likely identify more children with dyslipidemia. They recommend further research into the “costs of universal screening at the age 9 to 11 and 17 to 21 years and the effectiveness of this policy for identifying at-risk youth and lowering their risk of cardiovascular disease later in life.”
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