Lipid Screening in Children and Adolescents in Community Practice: 2007 to 2010

Study Questions:

What is the frequency of lipid screening in children, and what are the rates of abnormal lipid profiles?

Methods:

Data from three large integrated health care delivery systems were used for the present study. These centers included HealthPartners of Minnesota, Kaiser Permanente Colorado, and Kaiser Permanente Northern California, and all used the EpiCare electronic health record system. The cohort included children ages 3-19 years with one or more visits during the study period (January 1, 2007, to December 31, 2010). Patients with a diagnosis of dyslipidemia or conditions associated with abnormal lipids were excluded from the present analysis.

Results:

A total of 301,080 children and adolescents, enrolled in the three health systems between 2007 to 2010, were included in the present analysis. Overall, 9.8% of these children had their lipids measured during the study period. Testing varied by body mass index (BMI) percentile with a positive association between increased BMI and having lipids measured (5.9% of normal weight, 10.8% of overweight, and 26.9% of obese children). Age showed a similar pattern, with older children having lipids measured more frequently than younger children (8.9% of 9- to 11-year-olds and 24.3% of 17- to 19-year-olds). In normal weight patients, 2.8% of 9- to 11-year-olds and 22.0% of 17- to 19-year-olds were tested. In multivariable models, age and BMI category remained strongly associated with lipid testing. Sex, race, ethnicity, and blood pressure were weakly associated with testing. Abnormal lipid levels were found in 8.6% for total cholesterol, 22.5% for high-density lipoprotein cholesterol, 12.0% for non–high-density lipoprotein cholesterol, 8.0% for low-density lipoprotein cholesterol, and 21% for triglycerides (ages 10-19 years). There was a strong and graded association of abnormal lipid levels with BMI, particularly for high-density lipoprotein cholesteroland triglycerides (two- to six-fold higher odds ratio in obese when compared with that in normal weight children).

Conclusions:

The investigators concluded that lipid screening is not frequently performed among 9- to 11-year-olds and was performed in a minority of 17- to 19-year-olds.

Perspective:

Recent guidelines from the National Institutes of Health and endorsed by the American Academy of Pediatrics (published in 2011) recommend universal screening for lipids among children ages 9-11 and again at age 17-21 years. The authors sought to examine current practice patterns for lipid management prior to the publication of these recommendations. They observed that BMI and age were associated with more frequent testing and a higher likelihood of abnormal results, which may suggest such testing is more cost-effective in adolescents unless risk factors such as elevated BMI are present. Incorporating continued assessment into practice, as the 2011guidelines recommend, is warranted.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Dyslipidemia, CHD and Pediatrics and Prevention, Lipid Metabolism, Nonstatins

Keywords: Minnesota, Overweight, Lipids, Blood Pressure, Colorado, Child, Electronic Health Records, Cholesterol, Dyslipidemias, Body Mass Index, California, National Institutes of Health (U.S.), Triglycerides


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