Current Guideline Recommendations for Lipid Management in Patients Aged 17-21 Years | Journal Scan

Study Questions:

Do pediatric and adult guidelines differ for pharmacologic treatment of low-density lipoprotein (LDL) cholesterol among those aged 17-21 years?

Methods:

The authors used data from the National Health and Nutrition Examination Survey (NHANES; January 1999 to December 2012) for the analysis. The 2011 Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents from the National Heart, Lung, and Blood Institute were used for the pediatric guidelines, and the 2013 Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults from the American College of Cardiology and American Heart Association was used for the adult recommendations. Using NHANES sampling weights, the number of young people (aged 17-21 years) living in the United States who would be recommended for statin therapy was estimated for each of the guidelines reviewed.

Results:

A total of 6,338 participants aged 17-21 years in NHANES were included, of which 2.5% (95% confidence interval [CI], 1.8%-3.2%) would qualify for statin therapy based on the pediatric guidelines. In comparison under the adult guidelines, 0.4% (95% CI, 0.1%-0.8%) would be recommended for statin therapy. Under the pediatric guidelines, patients recommended for statin therapy would have lower LDL levels, but greater proportions of additional cardiovascular risk factors including hypertension, smoking, and obesity. Based on the NHANES numbers qualifying for statin therapy on either guidelines, an estimated 483,500 (95% CI, 482,100–484,800) young people aged 17-21 years would be eligible for treatment of LDL cholesterol under the pediatric guidelines, while an estimated 78,200 (95% CI, 77,600–78,700) would be eligible for treatment under the adult guidelines.

Conclusions:

The authors concluded that applying the pediatric guidelines for lipid levels would likely result in statin treatment for greater numbers of adolescents and young adults compared to the adult guidelines.

Perspective:

Different levels of evidence and opinion incorporated into guidelines is one factor leading to variation in guidelines. A large-scale randomized trial to address the appropriate group and age to start pharmacologic therapy will likely be too costly to attempt. Given the number of cardiovascular risk factors among young adults, understanding the risks and benefits associated with pharmacologic treatment of lipids through a large database is warranted.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, CHD & Pediatrics and Arrhythmias, CHD & Pediatrics and Prevention, CHD & Pediatrics and Quality Improvement, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Hypertension, Smoking

Keywords: Adolescent, American Heart Association, Cardiovascular Diseases, Cholesterol, Cholesterol, LDL, Guideline, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypertension, Lipids, Lipoproteins, LDL, National Heart, Lung, and Blood Institute (U.S.), Nutrition Surveys, Obesity, Risk Factors, Smoking, Young Adult, Primary Prevention, Metabolic Syndrome X


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