Improving Universal Pediatric Lipid Screening

Characteristics of Children Referred to a Lipid Clinic Before and After the Universal Screening Guidelines

“…Our study results suggest that many primary care physicians may not be performing routine universal lipid screening in their pediatric patients, a trend that is consistent with prior studies. [12][13][14][15][16][17] Alternatively, it is possible that referring providers were already screening for lipid concerns in the pre-guideline period. We did not obtain information from the referring physician on familiarity with the guideline, agreement with following what is proposed in the guideline, nor did we assess the level of implementation or having access to systems that facilitate guideline compliance.…”

“…11 Because many general pediatricians are not trained in the management of lipid-lowering medications, the NHLBI guidelines recommend that children with suspected primary dyslipidemia be referred to or managed in conjunction with a pediatric lipid specialist. 11 Overall physician adherence to the universal screening guideline has been low, [12][13][14][15][16][17] but even a modest increase in lipid screening will lead to a higher rate of abnormal lipid screen results, and also likely lead to more pediatric lipid clinic referrals for the management of primary dyslipidemia diagnoses, due to the high prevalence of familial hypercholesterolemia (FH; occurring in about 1 in 250-500). [18][19][20][21] Given that the purpose of universal screening is to detect patients whose primary dyslipidemia previously went unrecognized, it is plausible that the clinical characteristics of children seen in lipid clinics have changed after the adoption of the new guidelines.…”

Parental Knowledge and Attitudes About Universal Lipid Screening Among Children Aged 9 to 11 Years

“…9 Two recent studies have demonstrated significant improvement in ULS laboratory ordering in 9- to 11-year-old children by providers after clinic-based, educational, and electronic medical record interventions. The first study showed improvement in laboratory test ordering rates from 8.6% preintervention to 50.0% postintervention 10 and from 6.2% to 84.8% in the other study. 11 However, the cholesterol screening completion rates after a test was ordered was only 69.6% in the first study 10 and only 56.7% in the second study, 11 suggesting that there were additional logistical or attitudinal barriers to completion.…”

“…The first study showed improvement in laboratory test ordering rates from 8.6% preintervention to 50.0% postintervention 10 and from 6.2% to 84.8% in the other study. 11 However, the cholesterol screening completion rates after a test was ordered was only 69.6% in the first study 10 and only 56.7% in the second study, 11 suggesting that there were additional logistical or attitudinal barriers to completion. A recent study of a school-based universal cardiovascular screening program in middle school children concluded that more research is needed to understand why parents may or may not want their children screened.…”

Diabetes and family hypercholesterolemia in a child: is it real?

“…Одна из первичных форм -семейная гиперхолестеринемия. Это аутосомно-доминантное заболевание, возникающее у человека с рождения, сопровождающееся увеличением концентрации в крови общего холестерина, липопротеинов низкой плотности [3][4][5]. Гетерозиготная семейная гиперхолестеринемия в большинстве случаев связана с мутациями в следующих генах: гене рецептора липопротеинов низкой плотности LDLR (до 95% случаев), аполипопротеина В-100 APOB (4-5%) и пропротеинконвертазы субтилизин/ кексин 9-го типа PCSK9 (1%) [6].…”