The U.S. Preventive Services Task Force says there’s not enough evidence to recommend for or against pediatric high-cholesterol screening among asymptomatic children or teenagers.
In reaching this conclusion, the USPSTF reaffirmed its recommendation statement from 2007. The task force noted that whether to routinely screen children and adolescents is an often revisited topic because atherosclerosis starts when people are young, and lipid levels in younger people correlate with atherosclerosis in adulthood.
If children and teens are to be screened routinely, we need better evidence that screenings and corresponding interventions would lead to better cardiovascular health in those children when they become adults, the task force noted.
“Screening in children and adolescents may identify those with undiagnosed familial hypercholesterolemia or multifactorial dyslipidemia,” the task force stated. “However, the clinical health benefits and risks among children and adolescents identified with and treated for dyslipidemia have not been sufficiently studied, making the role of screening in children and adolescents uncertain.”
The task force did recommend screening children aged 6 and older for obesity.
The recommendation statement also bows to physician discernment when it comes to making the call to screen: “Clinicians should understand the evidence but individualize decision making to the specific patient or situation.”
The task force’s recommendation statement includes an almost throwaway line about cascade screening that may merit further investigation. Cascade screening involves finding cases among relatives of patients with confirmed familial hypercholesterolemia and testing for genetic variants identified in the proband. Cascade screening is done in the United Kingdom and the Netherlands, according to the task force, but not in the United States.