Should primary care clinicians screen asymptomatic children and adolescents for lipid disorders?
The USPSTF found inadequate evidence on the balance of benefits and harms of screening for familial hypercholesterolemia or dyslipidemia in asymptomatic children and adolescents aged 20 years or younger (I statement). Although the task force found no direct evidence of harm, screening could result in further unnecessary or harmful testing and treatment. This review did not address the issue of targeted screening based on family history of premature cardiovascular events. These recommendations are consistent with the 2016 USPSTF statement.
Plan de l'etude:
The US Preventive Services Task Force (USPSTF) found no clinical trials that assessed the direct benefits and harms of screening for lipid disorders in children and adolescents. Short-term trials of pharmacotherapy interventions have resulted in reduced lipid levels in children and adolescents, but there is no evidence of treatment resulting in a reduced incidence of premature cardiovascular disease. Similarly, there is no evidence that lifestyle modification (including weight loss) or pharmacotherapy interventions in children and adolescents with dyslipidemia reduce the incidence of premature cardiovascular disease. Although the USPSTF found inadequate evidence to assess the harms of screening, the task force recognizes that screening could result in the labeling of children with a "nondisease," leading to further unnecessary or harmful testing and treatment, as well as parental and child anxiety (ie, the vulnerable child syndrome). The National Heart, Lung, and Blood Institute's Expert Panel and the American Academy of Pediatrics recommend universal screening before adolescence (ages 9 years to 11 years) and again after puberty (ages 17 years to 21 years). Selective screening based on family history and risk factors is recommended for younger children starting at age 2 years. The American Academy of Family Physicians does not recommend for or against routine screening in children and adolescents 20 years or younger.
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Professor of Family Medicine, UNC Chapel Hill