USPSTF: Evidence is insufficient to support lipid disorder screening in asymptomatic kids

There is not yet enough evidence to adequately assess the benefit-harm balance of screening for lipid disorders in asymptomatic children and adolescents aged 20 years or younger, according to a statement from the U.S. Preventive Services Task Force.

The I draft recommendation statement aligns with the task force’s 2016 decision and calls for more research on the balance of risks and benefits when it comes to screening and treating for lipid disorders in children and adolescents who do not already show symptoms or have a cholesterol disorder.

The task force based its recommendation on a review of 272 articles and more than 7,000 abstracts with evidence on screening for high cholesterol mostly caused by environmental factors like obesity or a sedentary lifestyle and high cholesterol from a genetic mutation like familial hypercholesterolemia, two types of cholesterol disorders in adolescents and children.

Screening for both types of cholesterol disorders would entail a blood test that measures different components of cholesterol and further testing to confirm a diagnosis if cholesterol levels are elevated.

For both types of cholesterol disorders, screening would entail a serum lipid panel that measures different components of cholesterol.

“Our recommendation highlights the need for more research on whether or not screening children for high cholesterol improves their heart health into adulthood,” Li Li, MD, PhD, MPH, a task force member, said in a press release. “In the absence of this data, health care professionals should use their judgment on whether to measure the cholesterol levels of their young patients, and caregivers should share any concerns related to cholesterol or heart health.”

The USPSTF outlined several research needs and gaps in its draft recommendation statement, including:

• long-term data on the harms of screening and treatment;
• long-term data on the effectiveness of screening and treatment of lipid disorders in kids and adolescents to stave off premature CVD events or death later in life; and
• comparative effectiveness data that evaluates the best age at which to begin a lipid-lowering intervention for kids and adolescents, including the harms and benefits of starting pharmacologic treatment as a child versus a young adult.

“Despite this lack of evidence on cholesterol screening, the Task Force does recommend other evidence-based ways to promote good heart health in young patients, including screening and counseling for obesity,” Katrina Donahue, MD, MPH, another task force member, said in the release. “Good nutrition and physical activity habits begin in childhood and can improve cardiovascular health throughout life.”

References:

• Draft Evidence Review Screening for Lipid Disorders in Children and Adolescents. https://www.uspreventiveservicestaskforce.org/uspstf/document/draft-evidence-review/lipid-disorders-children-adolescents-screening. Published Jan. 24, 2023. Accessed Jan. 24, 2023.
• Draft Recommendation Statemen Screening for Lipid Disorders in Children and Adolescents. https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/lipid-disorders-children-adolescents-screening. Published Jan. 24, 2023. Accessed Jan. 24, 2023.
• U.S. Preventive Services Task Force Issues Draft Recommendation Statement on Screening Children for Lipid Disorders. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/child-lipid-screening-draft-rec-bulletin.pdf. Published Jan. 24, 2023. Accessed Jan. 24, 2023.