Lipid Screening in Childhood and Adolescence for Detection of Multifactorial Dyslipidemia: Evidence Report and Systematic Review for the US Preventive Services Task Force

• Published in: JAMA : the journal of the American Medical Association 2016-08, Vol.316 (6), p.634-644
• Main Authors: Lozano, Paula, Henrikson, Nora B, Morrison, Caitlin C, Dunn, John, Nguyen, Matt, Blasi, Paula R, Whitlock, Evelyn P
• Format: Article
• Language: English
• Subjects: Adolescent; Advisory Committees; Age Distribution; Age Factors; Atherosclerosis - diagnosis; Atherosclerosis - prevention & control; Biomarkers - blood; Child; Child, Preschool; Childrens health; Cholesterol - blood; Cholesterol, LDL - blood; Diet; Dyslipidemias - diagnosis; Dyslipidemias - epidemiology; Dyslipidemias - etiology; Dyslipidemias - therapy; Female; Humans; Hypolipidemic Agents - therapeutic use; Infant; Infant, Newborn; Life Style; Lipids; Male; Mass Screening - adverse effects; Mass Screening - methods; Medical screening; Myocardial Infarction - prevention & control; Preventive Health Services; Stroke - prevention & control; Systematic review; Task forces; United States - epidemiology; Young Adult
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2016.6423

IMPORTANCE: Multifactorial dyslipidemia, characterized by elevated total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C), is associated with dyslipidemia and markers of atherosclerosis in young adulthood. Screening for dyslipidemia in childhood could delay or reduce cardiovascular events in adulthood. OBJECTIVE: To systematically review the evidence on benefits and harms of screening adolescents and children for multifactorial dyslipidemia for the US Preventive Services Task Force (USPSTF). DATA SOURCES: MEDLINE, Cochrane Central Register of Controlled Trials, and PubMed were searched for studies published between January 1, 2005, and June 2, 2015; studies included in a previous USPSTF evidence report and reference lists of relevant studies and ongoing trials were also searched. Surveillance was conducted through April 9, 2016. STUDY SELECTION: Fair- and good-quality studies in English with participants 0 to 20 years of age. DATA EXTRACTION AND SYNTHESIS: Two investigators independently reviewed abstracts and full-text articles and extracted data into evidence tables. Results were qualitatively summarized. MAIN OUTCOMES AND MEASURES: Outcomes included dyslipidemia (TC≥200 mg/dL or LDL-C≥130 mg/dL) and atherosclerosis in childhood; myocardial infarction and ischemic stroke in adulthood; diagnostic yield (number of confirmed cases per children screened); and harms of screening or treatment. Simulated diagnostic yield was calculated as initial screening yield × positive predictive value from a study with confirmatory testing. RESULTS: Screening of children for multifactorial dyslipidemia has not been evaluated in randomized clinical trials. Based on 1 observational study (n = 6500) and nationally representative prevalence estimates, the simulated diagnostic yield of screening for elevated TC varies between 4.8% and 12.3% (higher in obese children [12.3%] and at the ages when TC naturally peaks—7.2% at age 9-11 years and 7.2% at age 16-19 years). One good-quality randomized clinical trial (n = 663) found a modest effect of intensive dietary counseling for a low-fat, low-cholesterol diet on lipid levels at 1 year in children aged 8 to 10 years with mild to moderate dyslipidemia; mean between-group difference in TC change from baseline was −6.1 mg/dL (95% CI, −9.1 to −3.2 mg/dL; P