The statement from the U.S. Preventive Services Task Force is
similar to the conclusion it reached in 2007, when members of the
panel last considered screening all children for lipid disorders.
"We looked at this evidence again and came to the conclusion . . .
that we donít have the evidence to recommend for or against
screening for dyslipidemia or lipid disorders," said pediatrician
Dr. David Grossman, vice chair of the USPSTF.
Lipid disorders, such as high cholesterol and triglycerides, are
tied to an increased risk of heart disease in adults, partly because
the high lipid levels contribute to plaque build-up in arteries.
For the new statement, published in JAMA, the USPSTF reviewed
evidence to evaluate potential benefits and harms of screening in
children. The point would be to look for a genetic condition known
as familial hypercholesterolemia as well as other lipid disorders
usually caused by lifestyle factors like diet and obesity.
Familial hypercholesterolemia is seen in about one of every 200 to
500 adults in Europe and North America, the panel writes. Treating
children with the genetic condition with medication resulted in
lower cholesterol levels, but the panel didn't find enough evidence
that it prevented deaths or cardiac events like heart attacks and
Similarly, the USPSTF did not find enough evidence that lifestyle
changes or medication use among children and adolescents with other
lipid disorders actually improved their health or prevented heart
disease. Between 7 and 8 percent of U.S. children and adolescents
have high lipid levels.
"The USPSTF concludes that the current evidence is insufficient and
that the balance of benefits and harms of screening for lipid
disorders in asymptomatic children and adolescents 20 years or
younger cannot be determined," the panel writes.
The USPSTF is in alignment with the American Academy of Family
Physicians on this matter, but other respected health organizations
do encourage childhood screenings for lipid disorders.
According to the National Heart, Lung and Blood Institute and the
American Academy of Pediatrics, some children at high risk for lipid
disorders - like those with a family history - should be screened
starting at age 2. Those organizations also say all children should
be screened for lipid disorders before adolescence and again after
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"There may be circumstances where screening or testing may be
appropriate," said Grossman. He added that doctors should make
decisions on a case-by-case basis.
For example, Grossman said, a doctor may decide to screen a child
whose family has a history of early heart attacks.
"Weíre not saying thatís wrong," he said. "That may be completely
Dr. Elizabeth Saarel, chair of pediatric cardiology at Cleveland
Clinic Children's, estimates that half of pediatricians screen
children for lipid disorders.
Part of the problem may be that pediatricians don't know how to
treat children and adolescents with lipid disorders, because there
hasn't been much research on treatments among younger people, said
Saarel, who was not involved with the new recommendations.
"Itís not the same population as adults with high cholesterol," she
told Reuters Health. "Yet, we have to apply the same treatment,
because we donít have the same drug trials Ė especially when it
comes to safety and efficacy."
Parents should discuss the issue of lipid screening with their
children's doctors, said Saarel. They should also bring up any
family history related to lipid disorders.
"Really, I think it does warrant a discussion with your doctor," she
SOURCE: http://bit.ly/2bh5uph JAMA, online August 09, 2016.
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