Lipid Testing: Why Screen and Fail to Act?

There has been controversy regarding the American Academy of Pediatric recommendations on lipid screening and treatment, mainly because the guidelines propose earlier screening and more aggressive treatment than other guidelines, including guidelines from the American College of Cardiology and the American Heart Association.  However, according to a recent article (N Joyce et al. J Pediatr 2015; 167: 113-9), it does not appear that many children (8-20 years) are actually being treated.

The authors used commercial health plan data between 2004-2010 and collected data from more than 13 million children.  Only 665 were initiated on lipid lowering therapy which equates to an incidence rate of 2.6/100,000 person-years.

Rates of lipid lowering therapy were higher in those ≥15 years with odds ratio of 2.9 and much higher in those with a familial hypercholesterolemia (OR 165.2).

Take home message from authors: “our findings suggest lipid lowering therapy is underutilized in this population.”   It is likely that many who have undergone testing and who have abnormal lipids are not being treated.  If so, why bother testing?

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