Cholesterol Screenings Staggeringly Low in Women of Childbearing Age
Pennsylvania study highlights a missed opportunity for OB/GYNs to screen women for dangerous cholesterol disorders.
Eight out of ten pregnant women have never had their cholesterol checked, despite clear recommendations for screening in early adulthood. These findings are based on a recent study of more than 5,000 women who gave birth at two Pennsylvania hospitals between 2009 and 2018.
High cholesterol is a common but dangerous condition that occurs when there’s excess fatty deposits in the blood. High cholesterol increases risk for life-threatening heart events. For some, there can be no warning signs until it leads to a heart attack or stroke.
Since cholesterol can be checked with a simple blood test, guidelines recommend routine screening in early adulthood. Screening may be recommended even earlier, especially in children or young adults with a family history of cholesterol disorders like familial hypercholesterolemia. These disorders can cause abnormally high cholesterol levels beginning as early as birth. As such, they require early diagnosis and treatment to avoid serious complications.
Given the clear guidelines, experts are even more shocked at the low rates of cholesterol screenings among women in their recent study
The study included 5,101 Pennsylvania women who gave birth in the past decade and completed a postpartum visit within six months of delivery. Among participants, only 22% had ever had their cholesterol checked despite being between 21–60 years of age and clearly meeting criteria to have had their cholesterol checked at least once, if not several times.
The American College of Cardiology (ACC) and the American Heart Association (AHA) recommend that all adults who are 20 years of age or older have a lipid profile screening. Additionally, the 2018 ACC/AHA Cholesterol Guideline says it may be reasonable to screen once between the ages of 9 and 11, and again between the ages of 17 and 21.
Researchers note that women who received cholesterol screenings tended to be older, white and have higher risk for heart disease. Based on available test results, researchers also found that 20% of women had moderately high cholesterol and 5% had severely elevated lipids, which could be a sign of a genetic cholesterol disorder.
As mentioned earlier, experts are particularly concerned about familial hypercholesterolemia (FH) going undiagnosed. FH affects an estimated 1 in 250 people, although experts believe rates may be even higher due to low screening rates and a lack of data.
“Finding and treating FH early is particularly critical,” said Dipika J. Gopal, MD, a fellow in the cardiovascular division at Hospital of the University of Pennsylvania and the study’s lead author. “If we can optimize cholesterol screening per the ACC/AHA guideline, we would more routinely identify inherited diseases and be able to do a cascade of testing and change the trajectory of a family’s life because it’s not just that woman, it’s also her children and other blood relatives who might be affected.”
However, it’s not just genetic cholesterol disorders that experts worry about going undiagnosed. High cholesterol affects about 1 in 3 American adults, and without routine screenings, a heart event can be the first sign of a lipid disorder. Early screening for elevated cholesterol levels would help identify those with high cardiovascular risk in need of lifestyle changes and treatment.
Based on their findings, Gopal said future research should look at how to institute a screening lipid panel and cardiovascular risk assessment as part of prenatal visits.
“Not nearly as many people as we think are actually getting cholesterol screening despite very clear recommendations,” said Gopal. “In fact, the number of patients who have ever been screened was staggeringly low, perhaps because they’re either not going to their primary care doctor or their doctor isn’t ordering the test.”
Since nearly every expectant mother will see a health care provider during pregnancy, it’s the perfect time to identify, counsel and treat patients with high cholesterol, according to authors.
“Up to 94 percent of pregnant women interact with a health care provider during pregnancy and after delivery compared to a much smaller percentage of non-pregnant patients within the same age group,” Gopal said. “The peri-partum period is a perfect time to capture a population that may otherwise not come into contact with the health system until many years later, perhaps when they have a first cardiovascular complication.”
Gopal adds, “Screening women for cholesterol has long-term implications on maternal and fetal health. Knowing if a woman has high cholesterol before pregnancy is also beneficial in assessing her cardiometabolic risk [a clustering of conditions that make diabetes and heart disease more likely even at young ages] and can allow us to more appropriately counsel in her pregnancy and for her future health.”