After careful reconsideration, the U.S. Preventive Services Task Force maintains that there’s a lack of evidence to support universal cholesterol screenings in children, as stated in their 2016 recommendations on early lipid screenings.
Published in the Journal of the American Medical Association, recommendations addressed screenings for lipid disorders in children and adolescents. Lipid screenings are blood tests used to measure cholesterol and triglycerides, both of which are related to risk for heart disease.
Currently, organizations like the National Heart, Lung and Blood Institute and American Heart Association support early lipid screenings to identify children with lipid disorders. Lipid disorders can cause abnormally high cholesterol levels at a young age. Experts argue that early diagnosis allows for earlier treatment, which could be lifesaving for patients. But in 2007, the U.S. Preventive Services Task Force found there was not enough evidence to support early lipid screenings in children. Little has changed since then, based on their latest update.
The 2016 recommendations considered early screening for lipid disorders, including familial hypercholesterolemia and multifactorial dyslipidemia. Familial hypercholesterolemia (FH) is a genetic disorder that causes abnormally high cholesterol levels starting at birth. Similarly, dyslipidemia is characterized by elevated LDL or total cholesterol levels. Both conditions are strongly linked to increased risk for heart disease, particularly at a young age.
After reviewing the latest research, the U.S. Preventive Services Task Force concluded that “current evidence is insufficient to assess the balance of benefits and harms of screening for lipid disorders in children and adolescents younger than 20 years.” In other words, they can’t say for sure whether early screening will improve outcomes in children diagnosed with lipid disorders. Experts worry that early screenings could cause more harm than good when implemented on a large scale.
For example, universal screenings could lead to overdiagnosis of lipid disorders, potentially causing unnecessary stress and costs for patients and their families. There is also a lack of trials that confirm safety and efficacy of cholesterol-lowering statins in children.
Many are discouraged by 2016 recommendations, since early lipid screening seems like a logical choice to improve public health. Familial hypercholesterolemia affects 1 in 250 individuals in the United States and, while underdiagnosed, is strongly linked to premature heart disease and death. Early detection would give patients a better chance at preventing or delaying heart disease. But unfortunately, the task force maintains that there’s just not enough evidence to endorse universal screening.
However, the task force also admits that “clinical decisions involve more considerations than evidence alone.” So while there’s not enough evidence to support universal screenings, clinicians should work with patients to make the most informed decisions possible. For example, early lipid screenings may be appropriate for patients with a family history of high cholesterol or premature heart disease. With additional research, it’s likely that guidelines will eventually be updated if early screenings are proven to improve outcomes in children with lipid disorders.