USPSTF issues neutral statement on lipid disorder screening in asymptomatic kids

Key takeaways:

• The USPSTF issued an I recommendation statement on screening asymptomatic children and adolescents for lipid disorders.
• The task force called for more evidence on screening and treating lipid disorders in kids.

There is not yet enough evidence to make a recommendation for or against screening for lipid disorders in asymptomatic children and adolescents aged 20 years or younger, according to the U.S. Preventive Services Task Force.

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

High cholesterol is a strong risk factor for disease, and when children and adolescents have high, uncontrolled cholesterol levels, they can face premature heart disease or death, Li Li, MD, PhD, MPH, Walter M. Seward professor and chair of family medicine at the University of Virginia (UVA) School of Medicine, director of population health at UVA Health, leader of the Cancer Prevention and Population Health program at the UVA Cancer Center and task force member, told Healio.

“It’s important to identify kids [with lipid disorders] at a young age,” he said. “Unfortunately, we found this insufficient evidence to assess the balance of benefits and harms of screening for all children who are asymptomatic for lipid disorders, and we’re calling for more research.”

The task force based its recommendation on a review of 43 studies with evidence on screening for two types of cholesterol disorders in adolescents and children: high cholesterol mostly caused by environmental factors like obesity or a sedentary lifestyle (multifactorial dyslipidemia) and high cholesterol from a genetic mutation (familial hypercholesterolemia, or FH). None of the randomized controlled trials directly addressed the harms and effectiveness of screening.

For both types of cholesterol disorders, screening would entail a blood test measuring different components of cholesterol and further testing to confirm a diagnosis if cholesterol levels are elevated.

The task force outlined research gaps and needs in its recommendation statement, including:

• long-term data on the effectiveness of screening for and treatment of lipid disorders in children and adolescents;
• comparative effectiveness data evaluating the optimal age at which to start lipid-lowering interventions for children and adolescents diagnosed with lipid disorders, including benefits and harms of starting pharmacologic treatment; and
• confirmatory lipid and genetic testing to measure the diagnostic yield of lipid screenings tests.

“In the absence of evidence, we encourage all PCPs to use their own judgment to assess whether they want to measure cholesterol levels in their young children,” Li said.

In a related editorial, Sarah D. de Ferranti, MD, MPH, an associate professor of pediatrics at Harvard Medical School, and colleagues wrote that childhood lipid screening would identify at least one abnormal lipid value in one of every five children aged 12 to 19 years.

Without universal screening, usual care currently fails to identify as many as nine of 10 individuals meeting phenotypic criteria for FH, they wrote.

“The current I statement from the USPSTF pushes the possibility of a systematic national childhood lipid screening program into the future,” de Ferranti and colleagues concluded. “However, we believe that the evidence supporting specific screening for and treatment of FH in childhood is growing, and a universal screening approach to reduce the burden of premature atherosclerotic cardiovascular disease among persons with FH will likely be adopted in the future. In the meantime, clinicians can rely on existing guidelines and decide together with pediatric patients and their families if and when to screen for lipid disorders in childhood.”

References:

• De Ferranti SD, et al. JAMA. 2023;doi:10.1001/jama.2023.11258.
• Guirguis-Blake JM, et al. JAMA. 2023;doi:10.1001/jama.2023.8867.
• USPSTF. JAMA. 2023;doi:10.1001/jama.2023.11330.