One in Nine Children Receive Lipid Screening

Credit: Pexels / Pavel Danilyuk

Fewer than 15 percent of children and adolescents receive lipid screening tests, despite emphasis from experts that universal screenings be implemented, according to new findings.

A study of data from the IQVIA Ambulatory Electronic Medical Record suggests interventions are needed to improve longterm cardiovascular risk assessment—particularly among the younger population. Investigators believe this research used the largest study population in assessing pediatric dyslipidemia screening rates—including more than 100,000 US clinics.

“The findings indicate that adherence to lipid screening recommendations among youths is low and that one in three of those screened have abnormal lipid levels, even higher among those with excess weight," investigators wrote.

A major driver of atherosclerotic cardiovascular risk, early diagnosis and management of dyslipidemias play a significant role in improving longterm prognosis of these patients. However, trends in use of lipid screening and prevalence of dyslipidemia among younger populations remain unclear.

With this in mind, investigators sought to evaluate the prevalence of ambulatory lipid screening and elevated or abnormal lipid measurements among pediatric patients, with further interest in assessing trends according to patient characteristics and test type. To do so, the team designed their research as a cross-sectional study of data that included more than three million youth patients aged nine to 21 years with data recorded from 2018 to 2021 for inclusion.

For the purpose of analysis, abnormal lipid measurements were defined using the following criteria:

• 200 mg/dL or more in total cholesterol
• 130 mg/dL or more in LDL-C
• 31 mg/dL or more in VLDL-C
• 145 mg/dL or more in non-HDL-C
• 100 mg/dL or more in triglycerides (if nine years old)
• 130 mg/dL or more in triglycerides (if 10 to 21 years old)

Of the 3.2 million identified for inclusion, 23.9 percent were aged 9 to 11 years, 34.8 percent were aged 12 to 16 years, and 41.3 percent were aged 17 to 21 years. Investigators also pointed out this cohort was 60 percent non-Hispanic White patients, 9.5 percent were Black, 2.4 percent were Asian, 0.7 percent were Hispanic, and 23.1 percent were of unknown race/ethnicity. Additionally, 56.5 percent had a healthy weight, 18.2 percent had overweight, 14.1 percent had moderate obesity, and 7.7 percent had severe obesity.

Upon analysis, results indicated just 11.3 percent of the study population had available lipid screening results. Investigators highlighted the frequency of lipid screening was generally low but varied across groups defined by age, race and ethnicity, and BMI category.

Of note, no single racial/ethnic group had a screening rate greater than 18.2 percent, which was observed among Asian youths. Additionally, investigators also highlighted screening was more likely to occur among those with severe obesity, moderate obesity, overweight, and underweight relative to those with a healthy weight.

Despite the low rate of screening, results suggested 59.3 percent had one or more elevated results, with 30.2 percent having one or more abnormal results. Further analysis found elevated lipid screening results were highest among patients aged 9 to 11 years relative to older age groups and among females relative to males.

An invited commentary from Stephen Daniels, MD, PhD, of Children’s Hospital Colorado, takes a stance similar to the study investigators, highlighting lipid screenings in children and adolescents as a way to mitigate long-term atherosclerotic cardiovascular risk in light of effective lifestyle and pharmacologic therapies. In the invited commentary, Daniels points to a number of drivers of the low rates of lipid screening in children and adolescents and calls attention to three specific reasons for greater implementation of lipid screening in this population: to better identify genetic dyslipidemias, to identify other family members with familial hypercholesterolemia, and to identify dyslipidemias associated with lifestyle.

“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,” Daniels wrote.

An original version of this article was published on sister site HCPLive.