UPSTF Recommends against Childhood Screening for Lipid Disorders
Recent estimates from the National Health and Nutrition Examination Survey (NHANES) indicate that 7.8% of children ages 8 to 17 years have elevated total cholesterol ?200 mg/dL and 7.4% of adolescents between the ages 12 and 19 years have elevated LDL cholesterol ?130 mg/dL.
Heterozygous familial hypercholesterolemia is an autosomal dominant disorder that occurs in approximately 1 out of every 200 to 500 persons in North America and Europe. Familial hypercholesterolemia is variably defined in the literature but generally includes highly elevated LDL cholesterol levels (e.g., ?190 mg/dL), genetic mutation, or both. Heterozygous familial hypercholesterolemia causes severe elevations in LDL cholesterol, resulting in early atherosclerotic lesions. It is generally asymptomatic in childhood and is rarely associated with cardiovascular events in the first two decades of life.
Alternatively, dyslipidemia can be multifactorial, with both polygenic and environmental determinants, including obesity. Multifactorial dyslipidemia includes elevated LDL cholesterol (?130 mg/dL), total cholesterol (?200 mg/dL), or both that are not the result of familial hypercholesterolemia. Obesity is associated with slight elevations in LDL cholesterol; it is more strongly related to elevated triglycerides and lower HDL cholesterol. Several longitudinal studies have documented an association between childhood lipid levels in this range and measures of atherosclerosis. Studies show that tracking lipid levels from childhood and adolescence to adulthood cannot predict which individuals will have elevated LDL or total cholesterol as adults. In addition, the association between multifactorial dyslipidemia in childhood and adolescence and clinical cardiovascular disease in adulthood is unknown.
The rationale for screening for lipid disorders in children and adolescents is that early identification and treatment of elevated LDL cholesterol could delay the atherosclerotic process and thereby reduce the incidence of premature ischemic cardiovascular events in adulthood.
The United States Preventive Services Task Force (USPSTF) found inadequate evidence on the quantitative difference in diagnostic yield between universal and selective screening for familial hypercholesterolemia or multifactorial dyslipidemia. They also found inadequate evidence to assess the harms of screening for familial hypercholesterolemia or multifactorial dyslipidemia.In a draft recommendation published on December 21, 2015, USPSTF concluded that current evidence is insufficient to assess the balance of benefits and harms of screening for lipid disorders in children and adolescents younger than age 20 years.
