Mainstream Medicine Still Reluctant to Order Lipid Panels for Kids

The practice of lipid screening in children still hasn’t taken off despite guideline recommendations to do so as early as age 9 years, according to a large cross-sectional study.

U.S. records show that the prevalence of documented lipid screening of outpatients ages 9 to 21 years was a low 11.3% from the years 2018 through 2021. Even for kids with severe obesity — an established risk factor for heart disease — screening for cholesterol and other lipids reached just 22%, reported Angela Thompson-Paul, PhD, MSPH, epidemiologist of the CDC in Atlanta, and colleagues.

Of the kids who were screened, 30.2% had at least one abnormal lipid result during the observation period, with abnormal results most common among pediatric patients with moderate obesity (42.5%) and severe obesity (48.5%), study authors showed in JAMA Network Open.

“Despite recommendations, screening practices might not have improved in more than a decade,” Thompson-Paul’s group wrote.

“Our study adds observational evidence that a large proportion of youths who receive screening have elevated lipid levels and might benefit from early intervention. This is a missed opportunity for referring children and families to guideline-recommended treatment, which includes lifestyle modification and the use of lipid-lowering medication,” the investigators stressed.

The idea is that early intervention would help reduce lifetime cardiovascular risk attributed to unfavorable lipid levels. Thompson-Paul and colleagues recommended that clinicians implement lipid screening in children ages 9-11, young adults ages 17-21, and all youths at high cardiovascular risk.

Yet the debate over pediatric screening has been ongoing for years.

Universal screening for dyslipidemia in the pediatric population, starting at age 9, is endorsed by the American Academy of Pediatrics, the American Heart Association, and the National Heart, Lung, and Blood Institute.

However, the U.S. Preventive Services Task Force still considers there to be insufficient evidence to judge lipid screening in children — likely adding to the uncertainty of healthcare providers.

“The pediatric recommendations have often seemed to be merely an extension of adult-focused recommendations, which may be confusing for those in pediatric practice. It is also likely that prevention of cardiovascular disease that occurs in adulthood is not top of mind for pediatric clinicians,” according to Stephen Daniels, MD, PhD, of University of Colorado School of Medicine and Children’s Hospital Colorado in Aurora.

He noted the unique considerations for lipid screening in pediatrics: identifying children with genetic lipid disorders (e.g., familial hypercholesterolemia [FH]) and their family members, and finding candidates who would benefit from early lifestyle changes.

“These results reflect the common misperception among the lay public and primary care clinicians that the most important lipid abnormalities are a result of increased adiposity. In fact, the most severe lipid abnormalities result from genetic dyslipidemias, such as FH, which are not usually associated with obesity,” Daniels wrote in an accompanying editorial.

“The results of the study by Thompson-Paul et al emphasize that a broader understanding of the rationale for pediatric lipid screening is needed to increase the prevalence of screening in practice and to improve the ability to prevent atherosclerotic cardiovascular events,” he added.

The study covered a large portion of pediatric primary care in the U.S. as it was based on outpatient records from the IQVIA Ambulatory Electronic Medical Record database. Study authors included people ages 9 to 21 years with weight and height measurements recorded during the study period, and wound up with a sample of over 3.2 million people (53.4% of them girls).

Lipid screening appeared more prevalent in children at older ages and higher BMIs.

Thompson-Paul and colleagues cautioned that their study should not be considered nationally representative as the records only covered people who sought healthcare. Additionally, they could not count lab tests that had not been linked to the IQVIA database.

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