The US Preventive Services Task Force (USPSTF) has again determined that current evidence is insufficient to recommend screening for lipid disorders among asymptomatic children and patients aged 20 years or younger.
The group’s final recommendation and corresponding evidence report were published July 17 in the Journal of the American Medical Association following a draft recommendation in January.
The organization reached a similar conclusion following its evaluation in 2016.
“There’s just not enough evidence to determine whether or not screening all children for high cholesterol improves their heart health into adulthood,” said Katrina Donahue, MD, MPH, a USPSTF member and a professor in the Department of Family Medicine at the University of North Carolina at Chapel Hill. “We’re calling for additional research on the effectiveness of screening for and treatment of high cholesterol in children and adolescents to prevent heart attacks, strokes, and death in adulthood.”
The task force recommended other evidence-based strategies to promote heart health, such as screening for obesity and interventions to prevent tobacco use.
The recommendation was the result of a review of 43 studies from MEDLINE and the Cochrane Central Register of Controlled Trials through May 16, 2022. No randomized controlled trial directly addressed the effectiveness or harms of lipid screening for children and adolescents. The task force continued to use article alerts and targeted journal searches through March 24, 2023.
Conditions such as familial hypercholesterolemia (FH) and multifactorial dyslipidemia can cause abnormally high lipid levels in children, potentially leading to premature cardiovascular events, such as myocardial infarction and stroke, and death in adulthood. According to the USPSTF, the prevalence of FH in US children and adolescents ranges from 0.2% to 0.4% (one in every 250–500 youth). Multifactorial dyslipidemia is more common ― the prevalence in children and adolescents ranges from 7.1% to 9.4%.
In an editorial response to the task force’s statement, the authors, including Sarah D. de Ferranti, MD, Department of Pediatrics at Harvard Medical School, question the impact of not screening children to identify FH and other conditions and caution against the subsequent delay in treatment.
“Treating FH during childhood slows the progression of vascular finding in atherosclerosis,” the authors write.
They note that the recommendation “leaves a void for clinicians seeking to provide care for patients today” while additional research is conducted.
Sarah Nosal, MD, a member of the board of directors of the American Academy of Family Physicians, said that despite the lack of a recommendation, primary care clinicians can still encourage proper nutrition and physical activity for patients.
Nosal said even without clear recommendations from the USPSTF, in the rare case of a patient with a family history of FH, she would order a lipid test and discuss treatment plans with the patient and family, if needed.
“We really don’t want to do tests that we don’t know what to do with the information,” she said.
One USPSTF member reported receiving grants from Healthwise, a nonprofit organization, outside the submitted work.
JAMA. 2023;330:253-260.
Robert Fulton is a journalist living in California.
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