PEDIATRICS Vol. 120 No. 1 July 2007, pp. e189-e214 (doi:10.1542/10.1542/peds.2006-1801)
SPECIAL ARTICLE |
Screening and Treatment for Lipid Disorders in Children and Adolescents: Systematic Evidence Review for the US Preventive Services Task Force
a Oregon Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology
b Department of Medicine
c Departments of Pediatrics and Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon
d Women and Children's Health Research Center, Providence Health System, Portland, Oregon
OBJECTIVE. This was a systematic evidence review for the US Preventive Services Task Force, intended to synthesize the published evidence regarding the effectiveness of selecting, testing, and managing children and adolescents with dyslipidemia in the course of routine primary care.
METHODS. Literature searches were performed to identify published articles that addressed 10 key questions. The review focused on screening relevant to primary care of children without previously identified dyslipidemias, but included treatment trials of children with dyslipidemia because some drugs have only been tested in that population.
RESULTS. Normal values for lipids for children and adolescents are defined according to population levels (percentiles). Age, gender, and racial differences and temporal trends may alter these statistical cut points. Approximately 40% to 55% of children with elevated total cholesterol and low-density lipoprotein levels will continue to have elevated lipid levels on follow-up. Current screening recommendations based on family history will fail to detect substantial numbers (30%–60%) of children with elevated lipid levels. Drug treatment for dyslipidemia in children has been studied and shown to be effective only for suspected or proven familial monogenic dyslipidemias. Intensive dietary counseling and follow-up can result in improvements in lipid levels, but these results have not been sustained after the cessation of the intervention. The few trials of exercise are of fair-to-poor quality and show little or no improvements in lipid levels for children without monogenic dyslipidemias. Although reported adverse effects were not serious, studies were generally small and not of sufficient duration to determine long-term effects of either short or extended use.
CONCLUSIONS. Several key issues about screening and treatment of dyslipidemia in children and adolescents could not be addressed because of lack of studies, including effectiveness of screening on adult coronary heart disease or lipid outcomes, optimal ages and intervals for screening children, or effects of treatment of childhood lipid levels on adult coronary heart disease outcomes.
Key Words: dyslipidemia • children • adolescents • mass screening • cholesterol • interventions
Abbreviations: TC—total cholesterol • LDL-C—low-density lipoprotein cholesterol • HDL-C—high-density lipoprotein cholesterol • CHD—coronary heart disease • FH—familial hypercholesterolemia • FCH—familial combined hyperlipidemia • AHA—American Heart Association • USPSTF—US Preventive Services Task Force • RCT—randomized, controlled trial • LRC—Lipid Research Clinics • AAP—American Academy of Pediatrics • NCEP—National Cholesterol Education Program • IMT—intima-media thickness
Accepted Jan 25, 2007.
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