USPSTF finds insufficient evidence to support lipid screening in children, adolescents

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After reviewing the available evidence, the U.S. Preventive Services Task Force (USPSTF) concluded there was insufficient evidence to assess the benefits and harms of screening for lipid disorders in children and adolescents under the age of 20.

The USPSTF published its findings in JAMA on Aug. 9 and also simultaneously posted them on its website. The agency commissioned two systematic evidence reviews on screening for lipid disorders in this age group. One review focused on screening for heterozygous familial hypercholesterolemia, while another focused on screening for multifactorial dyslipidemia.

The researchers defined dyslipidemia as an elevation in levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, non–high-density lipoprotein (non-HDL) cholesterol, triglycerides, or some combination thereof, as well as lower levels of HDL cholesterol. Meanwhile, they mentioned the definition of heterozygous familial hypercholesterolemia varied, but it generally includes an LDL cholesterol level of 190 mg/dL or higher, genetic mutation or both.

The researchers also cited data from the National Health and Nutrition Examination Survey that found 7.8 percent of children from 8 to 17 years old had total cholesterol of 200 mg/dL or higher, while 7.4 percent of adolescents from 12 to 19 years old had a LDL cholesterol level of 130 mg/dL or higher.

The USPSTF said it found adequate evidence from trials lasting two years or less that pharmacotherapy interventions led to substantial reductions in LDL cholesterol and total cholesterol in children with familial hypercholesterolemia. However, it found inadequate evidence about whether treatment with short-term pharmacotherapy reduced the risk of premature MI or stroke.

The researchers mentioned that between 2005 and 2010, the overall incidence rate of lipid-lowering pharmacotherapy in 8 to 20 years olds was 2.6 prescriptions per 100,000 person-years, according to claims data from health insurance plans. Another survey found that 3.2 percent of primary care visits for children and adolescents included screening for dyslipidemia.

The USPSTF said its recommendation was similar to the one it published in 2007.

“The USPSTF found inadequate evidence on the quantitative difference in diagnostic yield between universal and selective screening approaches,” the agency wrote. “There is inadequate evidence on the effectiveness and harms of long-term treatment and the harms of screening. The USPSTF also found inadequate evidence on the association between changes in intermediate outcomes (for example, lipid levels or noninvasive measures of atherosclerosis) and improvements in adult cardiovascular health outcomes. Therefore, the USPSTF concludes that the evidence on the benefits and harms of screening for lipid disorders in children and adolescents 20 years or younger is insufficient and that the balance of benefits and harms cannot be determined.”