Cholesterol Screening: Your Practice/Your Choice
The U.S. Preventive Services Task Force (USPSTF) recently published their 3rd evidence review for lipid screening in children and adolescents. On each iteration, the USPSTF concluded that there is “ no direct evidence on the benefits or harms of pediatric lipid screening.” In other words, the task force could not make a recommendation for or against cholesterol screening and early intervention (Grade “I” for indeterminate), leaving those in clinical practice to decide for themselves the best course of action.
Most of you will quickly realize that the USPSTF’s conclusion on this important topic is, unfortunately, problematic for clinicians for a number of reasons:
1. It mischaracterizes familial hypercholesterolemia (FH) as a “rare” condition, when in fact FH is one of the most common inherited conditions worldwide (1:220 in the U.S., 1:311 globally). 1 infant is born with familial hypercholesterolemia every many of the day!
2. The USPSTF can only include randomized control trials (RCTs) in their reviews. RCTs are tools designed for short-term evaluation (typically ∼ 5 years) and are, therefore, not expected to provide evidence of benefits of screening in a young population at the early stages of the disease process. BTW - the USPSTF previously came to the same “indeterminate” conclusion for a) skin cancer screening, b) smoking cessation support in adults, 3) hearing loss or vision screening in older adults, and 4) suicide risk and eating disorder screening in children and adolescents, to name just a few.
So, should you screen children for cholesterol in your practice? It’s up to you to decide. If you chose to do so, you are amongst thousands of colleagues who routinely follows practice guidelines endorsed by the NLA, ASPC, NHLBI, American Academy of Pediatrics, American College of Cardiology/American Heart Association, Pediatric Endocrine Society, American Association of Clinical Endocrinologists, American College of Endocrinology, and the European Atherosclerosis Society.