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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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.
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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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DOI: https://doi.org/10.1007/s12170-013-0320-2