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No direct evidence available to assess benefit of screening younger adults for dyslipidemia

Evidence is lacking to accurately evaluate the effects of screening for dyslipidemia in younger adults, according to investigators of the U.S. Preventive Services Task Force.

Any estimation of benefits and harms for this population would therefore have to be derived from studies of older adults, Roger Chou, MD, from the Pacific Northwest Evidence-Based Practice Center at Oregon Health & Science University, and colleagues wrote in the Annals of Internal Medicine.

They noted that many younger adults suffer from dyslipidemia despite its increasing prevalence with age, with approximately 36% of adults aged 20 to 29 years and 43% of adults aged 30 to 39 years meeting lipid recommendations from the National Cholesterol Education Program.

"Because of the asymptomatic nature of dyslipidemia before signs or symptoms of cardiovascular disease develop, its identification requires screening," Chou and colleagues wrote. "Detecting dyslipidemia in younger adults might enable management strategies, including lifestyle modification or medications, to be implemented to reduce the risk for cardiovascular events. Screening may be particularly beneficial in identifying young adults with markedly elevated lipid levels due to unrecognized familial hypercholesterolemia."

They conducted a review of available evidence to update lipid screening recommendations issued by the USPSTF in 2008.

Previous recommendations supported screening in men aged 20 to 35 years and women aged 20 to 45 years with coronary heart disease risk factors. The USPSTF based these recommendations on data that showed some younger adults with risk factors "have lipid levels sufficient to place them at high 10-year cardiovascular risk and might benefit from lipid-lowering therapies," as there was no direct evidence for these age groups.

Chou and colleagues searched MEDLINE, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews through May 2016 for case-control studies, cohort studies and randomized, controlled trials.

The search yielded no direct studies that evaluated the effects of screening for lipids vs. not screening, the effects of treatment vs. not treating or the effects of alternative screening strategies.

"Direct evidence regarding benefits and harms of dyslipidemia screening or treatment in younger adults remains unavailable," Chou and colleagues concluded. "Because very large, long-term trials would be required to evaluate screening of younger adults in the general population and may not be feasible, initial screening trials should consider targeting individuals with a family history of hypercholesterolemia or early [coronary heart disease], and initial treatment trials might target persons with very elevated lipid levels (such as those resulting from familial hypercholesterolemia), to increase statistical power. Trials of delayed vs. immediate lipid-lowering therapy for younger adults with dyslipidemia also would be helpful for understanding the effectiveness of earlier treatment, and studies are needed to understand harms associated with very long-term statin therapy." – by Chelsea Frajerman Pardes

Disclosures: The authors report a contract with the AHRQ during the conduct of the study.