Is universal lipid screening worthwhile?

Sarah de Ferranti, MD, director of the Preventive Cardiology Clinic at Boston Children’s Hospital, explained that what is controversial about the National Heart, Lung, and Blood Institute’s most recent set of guidelines addressing lipid screening in children is the call for universal screening at 2 time points: between 9 and 11 years of age and again between 17 and 21 years of age. “This represents a change in practice,” she said in a session titled “Universal lipid screening: Are pediatricians doing it and how is it working?” held on Monday.

Part of the reason for the change, de Ferranti explained, is that “it turns out that family history is not as good a way to screen for cholesterol problems as we thought it might be.”

“If your grandparents are in their 50s and have been on cholesterol lowering medicine for a long time, you may not know that there might have been a cholesterol problem in your family and that it was averted,” said de Ferranti.

In weighing whether universal lipid screening of children is useful, she said, “We are finding that there are a lot of lipid disorders out there that are not severe.” She reported that the prevalence of genetic cholesterol disorders is somewhere between 1/300 and 1/500, and said, “We’ll probably find what one might expect in terms of that, and those are the ones we really want to treat early.”

The vast majority of the problems revealed by the screening will be milder abnormalities, and she commented, “The question in my mind, and I don’t have the answer quite yet, is how much the screening helps those milder abnormalities?”

She lamented that the perfect set of data would come from screening high numbers of children and then looking at them 50 years later to objectively determine whether screening made a difference in outcomes. In the meantime, screening doesn’t really cause any harm. “It may be extra hassle and perhaps extra money,” she said, but it doesn’t, for example, cause unacceptable levels of parental anxiety or patient nervousness.