Selective pediatric cholesterol screening ‘misses at-risk individuals’
MedWire News: Using family history to guide selective blood cholesterol screening in children, as recommended by the US National Cholesterol Education Program (NCEP), misses many individuals who would be eligible for pharmacologic therapy, say researchers.
Susie Ritchie (West Virginia University, Morgantown, USA) and co-authors sought to determine the sensitivity and specificity of current guidelines issued by the NCEP Expert Panel on Blood Cholesterol Levels in Children and Adolescents.
The Panel endorses selective screening of three groups: those whose parents or grandparents have documented coronary artery disease before the age of 55 years; the offspring of a parent with blood cholesterol levels above 240 mg/dl; and those for whom family history is unknown, particularly those with other risk factors.
In this study, Ritchie's group studied 20,266 fifth-grade children who were participating in the Coronary Artery Risk detection in Appalachian Communities (CARDIAC) Project.
Analysis of fasting lipid profiles revealed that 71.4% of children met the NCEP criteria for screening on the basis of a family positive history. This figure far outstripped NCEP's projected figure of about 25%, the authors note.
Of the children who qualified for screening, 8.3% were found to have dyslipidemia, 14.1% of whom qualified for pharmacologic lipid-lowering therapy.
Surprisingly, though, of the children who did not qualify for screening, 9.5% had dyslipidemia, 17.9% of whom qualified for lipid-lowering therapy.
Correlation analyses suggested that a positive family history was significantly related to hyperlipidemia, but with a small effect size. Furthermore, family history had a poor specificity (0.63) and sensitivity (0.29) for predicting the need for pharmacologic therapy.
Ritchie et al conclude that universal rather than selective cholesterol screening may be a preferable approach for identifying dyslipidemia in the pediatric population.
"Universal cholesterol screening in the pediatric population will allow early diagnosis and appropriate treatment of children with significant dyslipidemia secondary to genetic and/or adverse lifestyle factors, hopefully preventing arterial disease," they say.l
"In addition, the added and undeniable benefit of identifying and screening parents and other first-degree relatives as a result of finding elevated low-density lipoprotein levels in their children could lead to the prevention of premature cardiac events in adults that may have otherwise gone undiagnosed."
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By Joanna Lyford