Few Youth Receive Lipid Screening, Highlighting Missed Opportunity to Reduce CVD Risk

Despite calls to implement universal screenings, new research indicates less than 15% of children and adolescents undergo lipid screening.

An analysis of data from the IQVIA Ambulatory Electronic Medical Record database, investigators suggest these results demonstrate an area for intervention to better improve long-term cardiovascular risk at a population level.¹

“To our knowledge, this cross-sectional study reflects the largest study population used to estimate pediatric dyslipidemia screening prevalence, using data from health care–seeking youths at more than 100,000 US clinical settings,” wrote investigators.¹ “The findings indicate that adherence to lipid screening recommendations among youths is low and that 1 in 3 of those screened have abnormal lipid levels, even higher among those with excess weight.”

A major driver of atherosclerotic cardiovascular risk, early diagnosis and management of dyslipidemias play a significant role in improving long-term prognosis of these patients. However, as investigators of the current study, who were led by Angela Thompson-Paul, PhD, MSPH, Division for Heart Disease and Stroke Prevention at the US Centers for Disease Control and Prevention (CDC), trends in use of lipid screening and prevalence of dyslipidemia among younger populations remains unclear.^1,2

With this in mind, Thompson-Paul and CDC 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, investigators designed their research endeavor as a cross-sectional study of data obtained from the IQVIA Ambulatory Electronic Medical Record database, which included provided investigators with data from 3,226,002 youth patients aged 9 to 21 years with data recorded from 2018 to 2021 for inclusion.¹

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 9 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% were aged 9 to 11 years, 34.8% were aged 12 to 16 years, and 41.3% were aged 17 to 21 years. Investigators also pointed out this cohort was 60% non-Hispanic White patients, 9.5% were Black, 2.4% were Asian, 0.7% were Hispanic, and 23.1% were of unknown race/ethnicity. Additionally, 56.5% had a healthy weight, 18.2% had overweight, 14.1% had moderate obesity, and 7.7% had severe obesity.¹

Upon analysis, results indicated just 11.3% 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%, which was observed among Asian youths. Additionally, investigators also highlighted screening was more likely to occur among those with severe obesity (aPR, 2.35; 95% CI, 2.33 to 2.37), moderate obesity (aPR, 1.58; 95% CI, 1.57 to 1.59), overweight (aPR, 1.18; 95% CI, 1.17 to 1.19), and underweight (aPR, 1.05; 95% CI, 1.03 to 1.07) relative to those with a healthy weight.¹

Despite the low rate of screening, results suggested 59.3% had 1 or more elevated results, with 30.2% having 1 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 (12 to 16 years: adjusted Prevalence Ratio [aPR], 0.91; 95% CI, 0.91 to 0.92; 17 to 21 years: aPR, 0.98; 95% CI, 0.97 to 0.99) and among females (aPR, 1.04; 95% CI, 1.03 to 1.04) relative to males.¹

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 3 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.²

“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.²

References:

1. Thompson-Paul AM, Kraus EM, Porter RM, et al. Pediatric Lipid Screening Prevalence Using Nationwide Electronic Medical Records. JAMA Netw Open. 2024;7(7):e2421724. doi:10.1001/jamanetworkopen.2024.21724
2. Daniels SR. Lipid Screening in Children and Adolescents—A Missed Opportunity to Improve Lifelong Health. JAMA Netw Open. 2024;7(7):e2421638. doi:10.1001/jamanetworkopen.2024.21638