Publisher's Synopsis
Dyslipidemias are disorders of lipoprotein metabolism, including elevations in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), or triglycerides (TG) or deficiencies of high-density lipoprotein cholesterol (HDL-C). These disorders can be acquired or familial and are related to genetic conditions such as familial hypercholesterolemia in some individuals. Children and adolescents with dyslipidemia may have dyslipidemia as adults. The relationship between dyslipidemia and coronary heart disease (CHD) in adults is well-established. The prevalence of other CHD risk factors, such as overweight, diabetes, and metabolic syndrome, is increasing among children and adolescents. Overweight is the primary factor contributing to development of metabolic syndrome in children and adolescents. The relationship between childhood and adult dyslipidemia, increasing prevalence of related CHD risk factors in children, as well as continued emphasis on primary prevention of CHD has raised interest in screening for dyslipidemia in children. Identification of children with dyslipidemia could lead to intervention services or treatment that might prevent or delay adult dyslipidemia and CHD. This rationale lends support to consideration of screening for dyslipidemia as part of routine well-child care and at other opportunities. This evidence synthesis focuses on the strengths and limitations of evidence about identifying and managing children and adolescents found to have dyslipidemia by screening in the course of routine primary care. Its objective is to determine the balance of potential benefits and adverse effects of screening for the development of guidelines by the U.S. Preventive Services Task Force (USPSTF). The target population includes children and adolescents age 0-21 years without previously known conditions associated with dyslipidemia. Among this population, there is potential to identify children and adolescents with dyslipidemia from among three groups: Those with undiagnosed monogenic dyslipidemias such as familial hypercholesterolemia (FH), those with undiagnosed secondary causes of dyslipidemia, and those with idiopathic dyslipidemia (polygenetic, multi-factorial or risk factor associated). Key Questions addressed include: KQ1. Is Screening for Dyslipidemia in Children/adolescents Effective in Delaying the Onset and Reducing the Incidence of CHD-related Events? KQ2. What is the Accuracy of Screening for Dyslipidemia in Identifying Children/adolescents at Increased Risk of CHD-related Events and Other Outcomes? KQ2a. What are Abnormal Lipid Values in Children/adolescents? KQ2b. What are the Appropriate Tests? How Well do Screening Tests (Non-fasting Total Cholesterol, Fasting Total Cholesterol, Fasting Lipoprotein Analysis) Identify Individuals with Dyslipidemia? KQ2c. How Well do Lipid Levels Track from Childhood to Adulthood? KQ2d. What is the Accuracy of Family History in Determining Risk? KQ2e. What are Other Important Risk Factors? KQ2f. What are Effective Screening Strategies for Children/adolescents (Including Frequency of Testing, Optimal Age for Testing)? KQ3. What are the Adverse Effects of Screening (Including False Positives, False Negatives, Labeling)? KQ4. In Children/adolescents, What is the Effectiveness of Drug, Diet, Exercise, and Combination Therapy in Reducing the Incidence of Adult Dyslipidemia, and Delaying the Onset and Reducing the Incidence of CHD-related Events (Including Optimal Age for Initiation of Treatment)? KQs5 - 8. What is the Effectiveness of Drug, Diet, Exercise, and Combination Therapy for Treating Dyslipidemia in Children/adolescents? KQ9. What are the Adverse Effects of Drug, Diet, Exercise, and Combination Therapy in Children/adolescents? KQ10. Does Improving Dyslipidemia in Childhood Reduce the Risk of Dyslipidemia in Adulthood? KQ11. What are the Cost Issues Involved in Screening for Dyslipidemia in Children/adolescents?
