Screening for Lipid Disorders in Children and Adolescents
Should routine lipid screening be completed for adolescents and young adults?
The US Preventive Services Task Force (USPSTF) updated their 2007 recommendations for screening for lipid disorders among children, adolescents, and young adults, with a review of the evidence. One review focused on screening for heterozygous familial hypercholesterolemia, and one review focused on screening for multifactorial dyslipidemia.
The USPSTF found inadequate direct evidence on the benefits of screening for familial hypercholesterolemia or multifactorial dyslipidemia. Evidence from short-term trials observed that pharmacotherapy was associated with significant reductions in low-density lipoprotein cholesterol among children with familial hypercholesterolemia, and one short-term trial observed reductions in carotid intima-media thickness. Inadequate evidence was found to support a reduction in the incidence of premature cardiovascular disease with pharmacologic therapy. The USPSTF found inadequate evidence on the benefits of lifestyle modification or pharmacotherapy interventions in children and adolescents with multifactorial dyslipidemia to improve intermediate lipid outcomes or atherosclerosis markers, or to reduce incidence of premature cardiovascular disease. The USPSTF also found inadequate evidence to assess the harms of screening for familial hypercholesterolemia or multifactorial dyslipidemia. The USPSTF found inadequate evidence to assess the long-term harms of treatment of familial hypercholesterolemia in children or adolescents.
The USPSTF concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for lipid disorders in children and adolescents 20 years or younger.
Long-term studies that assess the risks and benefits related to screening, including comparing screening methods related to familial hypercholesterolemia or multifactorial dyslipidemia, are needed in addition to a clear need for randomized trials of pharmacotherapies with outcomes that include intermediate markers of cardiovascular disease and long-term outcomes such as myocardial infarction and stroke.
Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Dyslipidemia, Noninvasive Imaging, Prevention, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Imaging, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Lipid Metabolism, Nonstatins, Primary Hyperlipidemia, Echocardiography/Ultrasound
Keywords: Adolescent, Atherosclerosis, Cardiovascular Diseases, Carotid Intima-Media Thickness, Child, Cholesterol, LDL, Dyslipidemias, Hyperlipoproteinemia Type II, Life Style, Pharmacology, Primary Prevention, Risk Assessment, Young Adult
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