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The US Preventive Services Task Force (USPSTF) has published updated recommendations on screening for high blood lipid levels in children and adolescents aged 20 years or younger.
What Are Lipid Disorders?
Lipids are chemical substances that are essential for the normal function of the body. Fats are a type of lipid. Lipids make up the cell membranes for all the cells in the human body and are involved in storing energy and also signaling between one part of the body and another. Lipids are also involved in the movement of substances from one place to another in the body, such as in moving the fats that people eat from the intestine to the liver for processing and also to fat cells for storage. Lipid levels in the blood that are too high are associated with heart disease, and people with high lipid levels are prone to having heart attacks and strokes.
What Tests Are Used to Screen for Lipid Disorders?
Blood lipids of concern include triglycerides and cholesterol. Measuring the levels of these lipids in blood is easy to do by taking a small blood sample after a patient has not eaten for about 12 hours.
What Is the Patient Population Under Consideration for Screening for Lipid Disorders?
The USPSTF reviewed publications on screening for lipid disorders in young people to determine if screening all young people for this problem is worthwhile. It limited its review to those aged 20 years or younger without known high lipid levels.
What Are the Potential Benefits and Harms of Screening for Lipid Disorders in Children and Adolescents?
Although blood lipid levels that are too high are usually a problem among older adults, young people can have high lipid levels caused by genetic disorders. Young people who have high lipid levels may be at risk of having heart attacks or strokes late in life. However, it is difficult to predict which children and adolescents with high lipid levels may be at risk as adults. Some clinicians believe that treatment of high lipid levels in children and adolescents may reduce the risk of heart attacks or strokes later on in life. If high levels of lipids are found, treatment with drugs such as statins can lower lipid levels. Based on the lack of currently available studies of this problem, it is not known if lowering lipid levels in young people reduces their risk of heart attacks or strokes later in life.
The first line of treatment, controlling diet and exercise, is not harmful. Medications used to lower lipids have few side effects. However, there is not much evidence on the long-term harms of using cholesterol medications in children and adolescents.
How Strong Is the Recommendation to Screen for Lipid Disorders in Children and Adolescents?
There are no studies definitively showing that screening for lipid disorders in children or adolescents is beneficial. There are no studies showing that screening causes significant harm. It is also not clear, because of a lack of evidence, that treating high cholesterol with lifestyle interventions or medications in children or adolescents leads to long-term improved heart health in adulthood.
Bottom Line: Current Recommendation for Screening for Lipid Disorders in Children and Adolescents
The USPSTF concludes that the current evidence is insufficient (called an “I” recommendation) to assess the balance of benefits and harms of screening for lipid disorders in children and adolescents aged 20 years or younger.
American Heart Associationwww.heart.org/HEARTORG/Conditions/Cholesterol/UnderstandYourRiskforHighCholesterol/Children-and-Cholesterol_UCM_305567_Article.jsp
National Library of Medicinewww.nlm.nih.gov/medlineplus/cholesterol.html
US Preventive Services Task Forcewww.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lipid-disorders-in-children-screening
A JAMA Patient Page on blood lipids was published in the October 23, 2013, issue; one on treatment of high cholesterol in the May 12, 2004, issue; one on cholesterol and atherosclerosis in the May 16, 2001, issue; and one on PCSK9 inhibitors for treating high cholesterol in the December 1, 2015, issue.
Sources: American Heart Association, National Institutes of Health
US Preventive Services Task Force. Screening for lipid disorders in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. doi:10.1001/jama.2016.9852.
Topic: Preventive Medicine
Livingston EH. Screening for Lipid Disorders in Children and Adolescents. JAMA. 2016;316(6):678. doi:10.1001/jama.2016.10945
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