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Lipid screening in children declined in recent years
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Despite proven benefits and treatments for early detection of hereditary CVD, childhood lipid screenings have declined during a 10-year period, according to a report in the Journal of Clinical Lipidology.
“Despite multiple expert panel recommendations since 1992 establishing the importance of identifying and treating youth with high-risk dyslipidemias including [familial hypercholesterolemia], our data show lipid testing and treatment rates from 2002 to 2012 did not increase in youth [but] actually appear to have decreased,” Justin P. Zachariah, MD, MPH, of the Texas Children’s Hospital, and colleagues wrote.
The researchers analyzed data of 653,642 children aged 2 to 20 years who were enrolled in five Cardiovascular Research Network sites for at least 12 months during the observation period. They examined the occurrence of lipid testing, lipid concentrations, pharmacy claims for lipid-lowering medicines, family history of CVD and obesity.
An average of 225,160 children were enrolled in the network each year. In that cohort, annual lipid testing decreased from 16% in 2002 to 11% in 2012 (P < .001).
In the entire cohort of children enrolled in the network, the proportion of patients with familial hypercholesterolemia (LDL < 190 mg/dL) increased from 0.03% in 2002 to 0.06% in 2012 (P = .03).
The researchers found no significant change in the initiation of lipid-lowering medicines (0.045%; P = .59) or statin use (0.028%; P = .25) from 2002 to 2012. Physicians did not treat children at high risk for familial hypercholesterolemia for myriad reasons: lack of screening; discomfort with lipid management; lack of familiarity with lipid value thresholds; opposition to lipid-lowering medicines; high costs of nontargeted screening; the lack of established clinical effectiveness for CVD event reduction; and the possibility of creating diet- or CVD-related neuroses and family conflict.
According to the researchers, if clinicians knew elevated pulse pressure predicted future hypertension, they might recommend lifestyle modifications even in nonobese children.
Efforts to expand pediatric lipid-screening initiatives include the development of an electronic tool to enhance clinician recognition of abnormal BP. When used in clinical practices, the tool may triple abnormal BP identification. Also, the researchers said provider and parental engagement quality-improvement initiatives should be implemented, along with inclusion of the variable length of follow-up and expanded demographics, especially of uninsured populations. – by Trish Shea, MA
Disclosure: The study was supported by grants from the NHLBI and Cardiovascular Research Network and Wilhelm Family Foundation. The researchers report no relevant financial disclosures.
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