USPSTF Recommendations

In August 2016, the US Preventive Services Task Force published its recommendation statement on screening for lipid disorders in children and adolescents, concluding that the current evidence is insufficient to assess the balance of benefits and harms of screening for lipid disorders in children and adolescents aged 20 years or younger (I statement). It is important to note that this is NOT a recommendation against universal screening, and the American Academy of Pediatrics, the American Heart Association; the National Heart, Lung, and Blood Institute; and the National Lipid Association all recommend screening for dyslipidemia in children and adolescents, especially to identify individuals with heterozygous familial hypercholesterolemia (FH), in addition to multifactorial dyslipidemia. FH occurs in up to 1 of every 250 persons in the United States, and although it is asymptomatic in the first several decades of life, if left untreated it is associated with a very high risk of early atherosclerotic cardiovascular disease. Currently, many adults with FH are not diagnosed until they have their initial cardiac event, and evidence exists that earlier identification and treatment (both lifestyle management and pharmacological intervention) could ameliorate this. Identifying children and adolescents with FH has the added advantage of recommending lipid screening in first- and even second-degree relatives to identify other cases in a more timely manner. The USPSTF recommendation is based on the lack of adequate randomized clinical trials that show screening asymptomatic children and adolescents can delay or reduce the incidence of myocardial infarction or stroke in adulthood. The USPSTF acknowledges that clinical decisions involve more considerations than evidence alone. Thus, the AAP recommendation for universal screening stands.

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4. Daniels SR. On the US Preventive Services Task Force statement on screening for lipid disorders in children and adolescents: One step forward and 2 steps sideways. Editorial. JAMA Pediatr. 2016;170(10):932-934.