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There is not enough evidence to support widespread screening of children for high cholesterol, according to an independent panel of US experts.
Insufficient evidence
The volunteer panel known as the US Preventive Services Task Force (USPSTF) has maintained the same stance it last took in 2007, in contrast to guidelines from other national groups like the American Heart Association (AHA).
"The current evidence is insufficient to assess the balance of benefits and harms of screening for lipid disorders in children and adolescents younger than 20 years," said the USPSTF, which makes recommendations on screenings, counselling services and preventative medications.
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The AHA and the National Lipid Association however do urge screening for unusually high cholesterol in kids – particularly those with a family history of heart disease – as a way to prevent damage from hardened arteries, said the report in the Journal of the American Medical Association (JAMA).
Those groups support cholesterol screening in children and adolescents as a strategy for identifying a genetic disorder that occurs in up to 1 of every 250 individuals in the United States, known as familial hypercholesterolemia.
Mounting evidence
According to data from the National Health and Nutrition Examination Survey, nearly eight percent of children aged 8-17 have elevated levels of total cholesterol (TC) and 7.4 percent of adolescents age 12 to 19 years have elevated LDL-C, also known as "bad cholesterol" because it can lead to clogged arteries.
An accompanying editorial in JAMA said that although there is mounting evidence in favour of childhood interventions for high cholesterol, "there may be harms associated with screening for dyslipidemia, as the USPSTF rightly points out".
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These may include overdiagnosis, higher costs and anxiety for the family, and "many youths with an isolated elevation in lipids will not develop early atherosclerotic cardiovascular disease," wrote Elaine Urbina of the Cincinnati Children's Hospital and Sarah de Ferranti of Boston Children's Hospital.
The doctors said long-term, randomised clinical trials are needed to better evaluate the benefits, harms and cost-effectiveness of various screening and treatment approaches.
In the meantime, the decision whether to screen or not remains largely up to individual doctors.
The USPSTF's review did find "adequate evidence" from short-term trials amounting to two years or less that medications like statins could lead to substantial reductions in cholesterol among children who inherit excess levels.
But the panel did not find enough evidence to show whether or not medical interventions in youth could lead "directly to a reduced incidence of premature cardiovascular disease".
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Familial hypercholesterolaemia
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