Task Force Sees No Need to Screen for Lipid Disorders in Children and Adolescents

Balance of benefits and harms can’t be determined from current evidence

The U.S. Preventive Services Task Force has released a final recommendation statement on screening for lipid disorders in children and adolescents. The Task Force concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for lipid disorders in individuals 20 years of age or younger. The group’s statement was published in the Journal of the American Medical Association.

Recent estimates from the National Health and Nutrition Examination Survey (NHANES) indicated that 7.8% of children 8 to 17 years of age have elevated levels of total cholesterol (greater than or equal to 200 mg/dL), and that 7.4% of adolescents 12 to 19 years of age have elevated low-density lipoprotein-cholesterol (LDL-C) (greater than or equal to 130 mg/dL). The rationale for screening for lipid disorders in children and adolescents is that early identification and treatment of elevated levels of LDL-C could delay the atherosclerotic process, thereby reducing the incidence of premature ischemic cardiovascular events in adults.

The USPSTF found inadequate evidence for a quantitative difference in diagnostic yield between universal and selective screening for familial hypercholesterolemia or multifactorial dyslipidemia. The Task Force also found inadequate direct evidence for the benefits of screening for familial hypercholesterolemia or multifactorial dyslipidemia.

The USPSTF found adequate evidence from short-term trials (durations of two years or less) that pharmacotherapy interventions result in substantial reductions in levels of total cholesterol and LDL-C in children with familial hypercholesterolemia. One short-term pharmacotherapy trial reported a reduction in carotid intima-media thickness. The USPSTF found inadequate evidence to address whether treatment with short-term pharmacotherapy leads directly to a reduced incidence of premature cardiovascular disease (e.g., myocardial infarction or stroke).

The Task Force also found inadequate evidence for an association between changes in intermediate lipid outcomes or noninvasive measures of atherosclerosis in children and adolescents and the incidence of or mortality from relevant adult health outcomes.

The USPSTF found inadequate evidence for the benefits of lifestyle modification or pharmacotherapy interventions in children and adolescents with multifactorial dyslipidemia to improve intermediate lipid outcomes or atherosclerosis markers, or to reduce the incidence of premature cardiovascular disease.

The Task Force found inadequate evidence to assess the long-term harms of treatment of familial hypercholesterolemia in children or adolescents. Long-term evidence on the treatment of familial hypercholesterolemia was limited to one study of statins. Short-term statin use was generally well tolerated in children and adolescents with familial hypercholesterolemia, with transient adverse effects, such as elevated liver enzyme levels. Treatment with bile acid-sequestering agents was commonly associated with gastrointestinal symptoms and poor palatability. The USPSTF also found inadequate evidence to assess the harms of treatment of multifactorial dyslipidemia in children or adolescents. One trial of a low-fat, low-cholesterol dietary intervention in children with multifactorial dyslipidemia showed no harms.

The Task Force concluded that the current evidence is insufficient, and that the balance of the benefits and harms of screening for lipid disorders in asymptomatic children and adolescents 20 years of age or younger cannot be determined.

Sources: USPSTF; August 9, 2016; and JAMA; August 9, 2016.