By Andrew M. Seaman
(Reuters Health) - A U.S. government-backed panel says there is not enough evidence to say all children should have blood tests to check for high levels of fat-like substances known as lipids.
The statement from the U.S. Preventive Services Task Force is similar to the conclusion it reached in 2007, when members of the panel last considered screening all children for lipid disorders.
“We looked at this evidence again and came to the conclusion . . . that we don’t have the evidence to recommend for or against screening for dyslipidemia or lipid disorders,” said pediatrician Dr. David Grossman, vice chair of the USPSTF.
Lipid disorders, such as high cholesterol and triglycerides, are tied to an increased risk of heart disease in adults, partly because the high lipid levels contribute to plaque build-up in arteries.
For the new statement, published in JAMA, the USPSTF reviewed evidence to evaluate potential benefits and harms of screening in children. The point would be to look for a genetic condition known as familial hypercholesterolemia as well as other lipid disorders usually caused by lifestyle factors like diet and obesity.
Familial hypercholesterolemia is seen in about one of every 200 to 500 adults in Europe and North America, the panel writes. Treating children with the genetic condition with medication resulted in lower cholesterol levels, but the panel didn’t find enough evidence that it prevented deaths or cardiac events like heart attacks and strokes.
Similarly, the USPSTF did not find enough evidence that lifestyle changes or medication use among children and adolescents with other lipid disorders actually improved their health or prevented heart disease. Between 7 and 8 percent of U.S. children and adolescents have high lipid levels.
“The USPSTF concludes that the current evidence is insufficient and that the balance of benefits and harms of screening for lipid disorders in asymptomatic children and adolescents 20 years or younger cannot be determined,” the panel writes.
The USPSTF is in alignment with the American Academy of Family Physicians on this matter, but other respected health organizations do encourage childhood screenings for lipid disorders.
According to the National Heart, Lung and Blood Institute and the American Academy of Pediatrics, some children at high risk for lipid disorders - like those with a family history - should be screened starting at age 2. Those organizations also say all children should be screened for lipid disorders before adolescence and again after puberty.
“There may be circumstances where screening or testing may be appropriate,” said Grossman. He added that doctors should make decisions on a case-by-case basis.
For example, Grossman said, a doctor may decide to screen a child whose family has a history of early heart attacks.
“We’re not saying that’s wrong,” he said. “That may be completely appropriate.”
Dr. Elizabeth Saarel, chair of pediatric cardiology at Cleveland Clinic Children’s, estimates that half of pediatricians screen children for lipid disorders.
Part of the problem may be that pediatricians don’t know how to treat children and adolescents with lipid disorders, because there hasn’t been much research on treatments among younger people, said Saarel, who was not involved with the new recommendations.
“It’s not the same population as adults with high cholesterol,” she told Reuters Health. “Yet, we have to apply the same treatment, because we don’t have the same drug trials – especially when it comes to safety and efficacy.”
Parents should discuss the issue of lipid screening with their children’s doctors, said Saarel. They should also bring up any family history related to lipid disorders.
“Really, I think it does warrant a discussion with your doctor,” she said.
SOURCE: bit.ly/2bh5uph JAMA, online August 09, 2016.