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Pediatric Lipid Screening and Treatment for Cardiovascular Disease Prevention: An Ounce or a Pound?

  • Pediatrics (S Gidding, Section Editor)
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Abstract

Although cardiovascular disease (CVD) mortality is declining, atherosclerosis-related diseases remain the leading cause of death. With the next frontier of CVD prevention focused on youth, the 2011 NHLBI Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents called for universal lipid screening of children ages 9–11 and adolescents ages 17–21 years. While atherosclerosis is rarely clinically evident in childhood, childhood risk factors have been linked to adult CVD events. Clinical controversies about screening and treatment exist, in part due to incomplete evidence, the long latency period between screening and adult CVD outcomes and the lack of information available about patient, provider and parent values and preferences. We describe clinical controversies in lipid screening and treatment for specific pediatric populations, highlight knowledge gaps limiting guideline development and implementation and consider innovative approaches that will further inform this discussion.

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Abbreviations

AAP:

American Academy of Pediatrics

ATP:

Adult Treatment Panel

CVD:

Cardiovascular disease

LDL-C:

Low-density lipoprotein cholesterol

FH:

Familial hypercholesterolemia

HDL-C:

High-density lipoprotein cholesterol

NHLBI:

National Heart, Lung, and Blood Institute

PCORI:

Patient-Centered Outcomes Research Institute

QoL:

Quality of Life

RCT:

Randomized controlled trial

TG:

Triglycerides

USPSTF:

US Preventive Services Task Force

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Acknowledgments

The authors would like to thank Tully Saunders, Thomas I. Mackie, MA, MPH and Angie Mae Rodday, MS, for their support in developing this manuscript.

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Conflict of Interest

Joshua Cohen received a PCORI grant for his institution and honoraria from Pfizer.

John Wong’s institution has received a PCORI grant and he receives salary support through Tufts Medical Center for editing the Informed Medical Decisions Foundation.

Laurel Leslie has received a PCORI grant for her institution.

Susan Parsons has received a PCORI grant for her institution.

Radley Sheldrick has received a PCORI grant for his institution.

Holly Gooding declares she has no conflict of interest.

Sarah de Ferranti declares she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Department of Cardiology, Boston Children’s Hospital, FA607, 300 Longwood Avenue, Boston, MA, 02115, USA

    Sarah D. de Ferranti, John B. Wong, Holly Gooding, Joshua T. Cohen, R. Christopher Sheldrick, Susan K. Parsons & Laurel K. Leslie

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  1. Sarah D. de Ferranti
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Correspondence to Sarah D. de Ferranti.

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de Ferranti, S.D., Wong, J.B., Gooding, H. et al. Pediatric Lipid Screening and Treatment for Cardiovascular Disease Prevention: An Ounce or a Pound?. Curr Cardiovasc Risk Rep 7, 261–269 (2013). https://doi.org/10.1007/s12170-013-0320-2

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