Universal Lipid Screening: In Response to Ongoing Debate Response
(Impact Factor: 5.47).
04/2013; 131(4):e1387-8. DOI: 10.1542/peds.2012-3818D
Available from: Vaneeta Bamba
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Cardiovascular disease is a leading cause of morbidity and mortality. Early identification and treatment of risk factors that accelerate this condition are paramount to preventing disease. To this effect, the National Heart Lung and Blood Institute (NHLBI), endorsed by the American Academy of Pediatrics, issued updated pediatric guidelines for cardiovascular risk reduction in 2011. Integration of these guidelines into pediatric practice may lessen cardiovascular morbidity.
In addition to reviewing the NHLBI guidelines, a detailed literature search was performed on PubMed for clinical studies published between 2010 and 2013. Key search terms included "pediatric dyslipidemia/hyperlipidemia," "cardiovascular disease," "atherosclerosis," "familial hypercholesterolemia," "hypertriglyceridemia," and "diabetes." Additional citations from these publications were also reviewed. Final publications were selected for their relevance to the topic.
These guidelines contain several important recommendations relative to lipid management, including screening all children with nonfasting non-high-density lipoprotein-cholesterol at ages 9-11 years, incorporation of aggressive lifestyle changes to meet cholesterol targets, and initiation of statin therapy for those with low-density lipoprotein-cholesterol elevation. In addition, both type 1 and type 2 diabetes are now considered high-risk conditions and have stringent cholesterol targets. The primary aim is early identification of children with familial hypercholesterolemia; however, these recommendations have met with some controversy. The purpose of this update is to summarize these recent lipid guidelines, present the relevant controversies, highlight common cholesterol disorders, and discuss dyslipidemia specific to the pediatric diabetes population.
Identification and treatment of youth with dyslipidemia is of paramount importance to the reduction of future cardiovascular disease. Increasing the comprehension and application of the newest NHLBI guidelines is critical to improving cardiovascular outcomes.
Available from: Robert A Hegele
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ABSTRACT: Familial hypercholesterolemia (FH) is the most common genetic disorder causing premature cardiovascular disease and death. Heterozygous FH conservatively affects approximately 1:500 Canadians, and the more serious homozygous form affects approximately 1:1,000,000 Canadians, although these numbers might be underestimated. Of approximately 83,500 Canadians estimated to have FH, most are undiagnosed, which represents a simultaneous public health deficit and opportunity, because early treatment of heterozygous FH can normalize life expectancy. Diagnostic algorithms for FH incorporate increased plasma low-density lipoprotein cholesterol, pathognomonic clinical features, and family history of early cardiovascular disease and hyperlipidemia. DNA-based detection of causative mutations in FH-related genes can help with diagnosis. Maximizing diagnosis and treatment of FH in Canada will involve a multipronged approach, including: (1) increasing awareness of FH among health care providers and patients; (2) creating a national registry for FH individuals; (3) setting standards for screening, including cascade screening in affected families; (4) ensuring availability of standard-of-care therapies, in particular optimization of plasma low-density lipoprotein cholesterol levels and timely access to future validated therapies; (5) promoting patient-based support and advocacy groups; and (6) forming alliances with international colleagues, resources, and initiatives that focus on FH. This document aims to raise awareness of FH nationally, and to mobilize knowledge translation, patient support, and availability of treatment and health care resources for this underrecognized, but important medical condition.
Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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ABSTRACT: Screening a healthy population for future harmful diseases has the potential of reducing the risk of later morbidity and mortality with early identification and intervention. However, it is important that the screening meets acceptable standards and the benefits of the screening outweigh risks. The recently published “Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents”1 (NHLBI Guidelines) carefully examined the multiple risk factors for coronary artery disease that begins in childhood but may not become problematic until years later. The evidence-based guidelines give many recommendations that are focused on identification, prevention and intervention. Included in the guidelines are useful suggestions for improving lifestyle and food choices. In the section on Lipids and Lipoprotein, careful consideration was given to universal screening of children between 9 to 11 years of age with no known cardiac risk factors and again, if needed, between 17 and 21 years of age. Children with cardiac risk factors may be screened earlier. The section continues with rationale for medical management of children who are refractory to other interventions. The purpose of this paper is to discuss the benefits of screening for dyslipidemia in the pediatric population and when necessary, medical management to reduce the risk for coronary artery disease. Both universal screening and early intervention in the pediatric population will identify individuals not previously recognized at risk for premature coronary artery disease and stroke, and reduce the incidence of later morbidity and mortality.
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