Lipid screening in childhood for detection of multifactorial dyslipidemia a systematic evidence review for the U.S. Preventive Services Task Force
BACKGROUND: For purposes of this report, multifactorial dyslipidemia refers to dyslipidemias involving elevated total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C) that are not familial hypercholesterolemia (FH). There is evidence that elevated TC and LDL-C concentrations in childh...
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| Corporate Authors: | , , , |
| Format: | eBook |
| Language: | English |
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Rockville, MD
Agency for Healthcare Research and Quality
2016, August 2016
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| Series: | Evidence syntheses
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| Subjects: | |
| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | BACKGROUND: For purposes of this report, multifactorial dyslipidemia refers to dyslipidemias involving elevated total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C) that are not familial hypercholesterolemia (FH). There is evidence that elevated TC and LDL-C concentrations in childhood, and especially adolescence, are associated with markers of atherosclerosis in young adults. CONCLUSIONS: We found no direct evidence for an effect of cholesterol screening on intermediate or health outcomes. Only one study provided a diagnostic yield for TC screening (5.8%). Simulated diagnostic yields in data from large U.S. population-based studies show variation in TC concentrations by age and body mass index. There were no studies of diagnostic yield in selective screening and no studies on the harms of screening. No evidence was found for an effect of treatment on health outcomes in adulthood (MI and stroke). Dietary counseling may lower TC and LDL-C concentrations by 5 to 7 mg/dL over 3 years, but this intervention was relatively intensive and the effect on lipids dissipates by 5 years. No studies of lipid-lowering medications met the inclusion criteria. There is fair evidence of the safety of dietary intervention in 8- to 10-year-olds. In one longitudinal study using NHANES data combined for both sexes, neither very high nor moderately increased TC concentrations in 12- to 39-year-olds was independently associated with death before age 55 years. Research needs include randomized trials of screening strategies with confirmatory testing and long-term followup, as well as rigorous RCTs of promising medications, supplements, and dietary interventions with long-term followup. Long-term followup of pediatric cohorts is needed to better establish the long-term health risks conferred by elevated concentrations of TC and LDL-C. Although not the focus of this systematic review, our findings support a re-examination of the commonly accepted fixed NCEP thresholds indicating elevated TC and LDL-C concentrations and a reconsideration of age- and sex-specific thresholds |
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| Physical Description: | 1 PDF file (x, 107 pages) illustrations |