Pediatric Lipid Screening and Treatment for Cardiovascular Disease Prevention: An Ounce or a Pound?
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.
KeywordsCholesterol Dyslipidemia Screening Comparative effectiveness Decision analysis Statin
American Academy of Pediatrics
Adult Treatment Panel
Low-density lipoprotein cholesterol
High-density lipoprotein cholesterol
National Heart, Lung, and Blood Institute
Patient-Centered Outcomes Research Institute
Quality of Life
Randomized controlled trial
US Preventive Services Task Force
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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