New guidelines from the NHLBI and the American Academy of Pediatrics recommend that all children between the age of 9 and 11 should undergo cholesterol screening. Screening should then be repeated at 17 and 21 years of age. The new guidelines are scheduled to be officially introduced by panel member Patrick McBride at the AHA in Orlando on Sunday.
“Previous targeted screening missed more than 50 percent of children with high cholesterol,” McBride told ABC News. “Atherosclerosis begins very early in life, even in infancy for children with genetic cholesterol problems. So increased screening is a necessary step.”
But the guidelines are likely to meet with considerable skepticism. One highly knowledgeable expert told CardioBrief that the new recommendations are not justified:
I do not think it is evidence based. I think it is a real reach. It muddles together different messages about finding genetic dyslipidemias – which need drug treatment – and improving lifestyle. For those without genetic dyslipidemia, you don’t need screening to advise about healthy lifestyle changes, and there is zero evidence that scaring people – especially children – leads to successful behavior change. For those with genetic dyslipidemia – lets remember FH only affects 1/500 – 2/3 are picked up by targeted screening. So for every 750 kids we screen, we find one kid with FH and put him or her on a drug 10 years earlier than we otherwise would have. Not much of a gain for the expense, pain, anxiety, and potential labeling/stigmatization of all the others. And we do not know the safety of these drugs in teens – we take for granted that they are safe because drug companies and the FDA said so. This is a distraction from the real changes our society needs, increases the cost of health care, and is a huge boon for the makers of cholesterol drugs and screening tests. I would refuse to let my kids get screened.”
Two Year Delay?
One other interesting sidenote to this story: although the news broke two days earlier than anticipated because of some aggressive reporting from the AP (here’s a look behind-the-scenes), the guidelines have been languishing at the NHLBI for two years or more. Note that the publication of the guidelines in Pediatrics discloses that the manuscript was accepted for publication on August 4, 2009. I have been told that several frustrated panel members threatened to resign over NHLBI delays in moving forward with the project.
Click here to read CardioBrief’s previous coverage about cholesterol screening guidelines in children from the National Lipid Association.