Paediatric screening for hypercholesterolaemia in Europe: Table 1

Abstract

Different screening strategies are currently recommended to identify children with (familial) hypercholesterolaemia in order to initiate early lipid management. However, these strategies are characterised to date by low adherence by the medical community and limited compliance by parents and children. In a literature review, the authors assess which children should undergo screening and which children are in effect identified through the currently recommended strategies. Furthermore, the authors discuss the different screening tools and strategies currently used in Europe and what is known about the negative aspects of screening. The authors conclude that currently recommended selective screening strategies, which are mainly based on family history, lack precision and that a large percentage of affected children who are at increased risk of future coronary artery disease are not being identified. The authors propose universal screening of children between 1 and 9 years of age, a strategy likely to be most effective in terms of sensitivity and specificity for the identification of children with familial hypercholesterolaemia. However, this concept has yet to be proven in clinical practice.

Statin treatment of children with familial hypercholesterolemia – Trying to balance incomplete evidence of long-term safety and clinical accountability: Are we approaching a consensus?

“…В Евро-пе рекомендуют универсальный скрининг до 20 лет, в идеале -до наступления пубертатного возраста. Этот вид скрининга проводится в Словении и тести-ровался в некоторых университетах Японии, но его результативность и экономическая эффективность пока неясны [22].…”

Integrated guidance on the care of familial hypercholesterolaemia from the International FH Foundation

“…Statins reduce the risk for cardiovascular events [108][109][110][111][112][113] and progression of atherosclerosis in FH [56], and their use is cost-effective [77,114,115]. Adjuvant therapy with ezetimibe, bile acid sequestrants, plant stanols/sterols, and niacin (or its derivatives) may often also be required [21,[116][117][118][119][120]. Patients may require 3 or more drugs to achieve adequate LDLcholesterol reduction, which is particularly important in secondary prevention [8,18,120].…”

Relationship between genetic and environmental factors and hypercholesterolemia in children

“…Although the specificity of a positive FMH was low, as reported in other studies, 23 its sensitivity was adequate, so it may be considered a predictor of hypercholesterolemia in this type of population, as suggested by pediatric societies.…”

“…18 The SAP, in its latest consensus meeting, suggested the universal screening for children aged 6 to 11 years old, which is precisely what we did in this study. 24 An analysis done by Kusters et al 23 regarding several European countries indicates that the screening based on FMH lacks accuracy and there is a high proportion of children who are left undiagnosed. The Netherlands, Norway, and the United Kingdom have a familial hypercholesterolemia detection program based on a deoxyribonucleic acid (DNA) test done in family groups and an adequate technique, but it is costly.…”