Compliance With Childhood Cholesterol Screening Among Members of a Prepaid Health Plan

Bachman, Ronald; Schoen, Edgar J.; Stembridge, Ann; Jurecki, Elaina; Imagire, Robin S.

doi:10.1001/archpedi.1993.02160280032013

Cited by 16 publications

(11 citation statements)

References 23 publications

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“…Generally, studies of the targeted approach have found that 35% to 46% of children and adolescents have had their cholesterol levels measured on the basis of a positive family history of CVD or elevated cholesterol concentration. [25][26][27][28][29] The reasons for this variability may be that populations may differ in adult prevalence of CVD or in the implementation of the default screening strategies for children and adolescents when family history is unknown or when other risk factors, including obesity and blood pressure elevation, are present. With the prevalence of obesity increasing 30 and the possibility that the prevalence of high blood pressure is also increasing, 31 this would lead to an increase in the percentage of children and adolescents who would qualify for having their cholesterol concentration determined.…”

Section: Clinical Evaluationmentioning

confidence: 99%

Lipid Screening and Cardiovascular Health in Childhood

Daniels¹,

Greer²

2008

Pediatrics

1,037

765

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This clinical report replaces the 1998 policy statement from the American Academy of Pediatrics on cholesterol in childhood, which has been retired. This report has taken on new urgency given the current epidemic of childhood obesity with the subsequent increasing risk of type 2 diabetes mellitus, hypertension, and cardiovascular disease in older children and adults. The approach to screening children and adolescents with a fasting lipid profile remains a targeted approach. Overweight children belong to a special risk category of children and are in need of cholesterol screening regardless of family history or other risk factors. This report reemphasizes the need for prevention of cardiovascular disease by following Dietary Guidelines for Americans and increasing physical activity and also includes a review of the pharmacologic agents and indications for treating dyslipidemia in children. Pediatrics 2008;122:198-208 INTRODUCTION Cardiovascular disease (CVD) is the leading cause of death and morbidity in the United States. 1 Most of the clinical burden of CVD occurs in adulthood. However, research over the last 40 years has increasingly indicated that the process of atherosclerotic CVD begins early in life and is progressive throughout the life span. 2 It has also become clear that there is an important genetic component to the disease process that produces susceptibility but that environmental factors, such as diet and physical activity, are equally important in determining the course of the disease process.This statement replaces the outdated 1998 American Academy of Pediatrics (AAP) policy statement "Cholesterol in Childhood," which has been retired. 3 New data emphasize the negative effects of excess dietary intake of saturated and trans fats and cholesterol as well as the effect of carbohydrate intake, the obesity epidemic, the metabolic/insulin-resistance syndrome, and the decreased level of physical activity and fitness on the risk of adult-onset CVD. In addition, more data are now available on the safety and efficiency of pharmacologic agents used to treat dyslipidemia. Most of these data were not available at the time of the previous statement.A number of studies have identified potential risk factors for adult CVD. 4 The strongest risk factors include a high concentration of low-density lipoprotein (LDL), a low concentration of high-density lipoprotein (HDL), elevated blood pressure, type 1 or 2 diabetes mellitus, cigarette smoking, and obesity. Research in children and adolescents has demonstrated that some of these risk factors may be present at a young age, 5 and pediatricians must initiate the lifelong approach to prevention of CVD in their patients. The focus of this report is on improving lipid and lipoprotein concentrations during childhood and adolescence to lower the lifelong risk of CVD. The current obesity epidemic among children has increased the need for pediatric health care professionals to be knowledgeable of the risk factors for CVD and to implement the changes recommended in...

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Section: Clinical Evaluationmentioning

confidence: 99%

Lipid Screening and Cardiovascular Health in Childhood

Daniels¹,

Greer²

2008

Pediatrics

1,037

765

View full text Add to dashboard Cite

show abstract

“…38 A study of 1160 children and adolescents in a prepaid health plan in California found that 46% had a family history of premature cardiovascular disease or parental hypercholesterolemia. 39 Thus, the panel clearly underestimated the number of children who would be targeted for screening.…”

Section: Challenges With These Existing Guidelinesmentioning

confidence: 99%

“…In a study of children in a prepaid health plan, only 70% of parents whose child was identified with a positive family history complied with the recommendation to have their child's total cholesterol level determined. 39 Of those children initially screened and noted to have a total cholesterol level that was moderately high (Ն4.9 mmol/L; Ն190 mg/dL), only 62% had the recommended second measurement. Children whose LDL cholesterol level was found to be moderately high (Ն3.25 mmol/L; Ն125 mg/dL) were offered the opportunity to participate in a 3-to 6-week nutrition program, yet only 36% of parents enrolled.…”

Section: Challenges With These Existing Guidelinesmentioning

confidence: 99%

Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents

McCrindle¹,

Urbina

Dennison³

et al. 2007

Circulation

363

149

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Abstract-Despite compliance with lifestyle recommendations, some children and adolescents with high-risk hyperlipidemia will require lipid-lowering drug therapy, particularly those with familial hypercholesterolemia. The purpose of this statement is to examine new evidence on the association of lipid abnormalities with early atherosclerosis, discuss challenges with previous guidelines, and highlight results of clinical trials with statin therapy in children and adolescents with familial hypercholesterolemia or severe hypercholesterolemia. Recommendations are provided to guide decision-making with regard to patient selection, initiation, monitoring, and maintenance of drug therapy.

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“…[43][44][45] On the other hand, if early identification proves to be beneficial, the alternative in this age group, targeted screening, misses a significant proportion of children with dyslipidemia, especially in areas with low knowledge of family history. 46,47 Additional studies should explore the benefits of childhood screening in identifying adults at high risk of CVD, such as in the CARDIAC project. 22,24 Our review and its included studies have limitations.…”

Section: Costs and Cost-effectiveness Of Screeningmentioning

confidence: 99%