[메디칼업저버 박선혜 기자] As the incidence of obesity, which increases cholesterol levels, increases in children and young people, the importance of screening for lipid disorders is emerging, but it seems difficult to carry out the test universally yet.
The US Disease Prevention Service Task Force (USPSTF) published a draft on its website on the 24th (local time) saying it could not make recommendations about whether all children and young people under the age of 20 should be screened for lipid disorders.
That is why there is insufficient evidence to evaluate the benefits and risks of lipid disorder screening in children and young people.
This draft is consistent with the 2016 Recommendation. At the time, the USPSTF did not recommend a lipid disorder screening test for children and young people because there was no reasonable basis for recommending it, and it was concluded that a planned clinical study was needed well targeting that age.
Professor Katrina Donahue from the University of North Carolina, USA, who is a member of the USPSTF, said, “To make a decision on the recommendation, we need to decide that the benefits outweigh the risks. The long-term benefits and risks of cholesterol-lowering therapy in children and young people are also not well known.”
The USPSTF plans to request comments on this draft recommendation by the 21st of next month.
There is no study that directly evaluated the benefits of screening and early treatment.
The reason why it is necessary to clarify whether lipid disorder screening is necessary for all children and young people is that familial hypercholesterolemia or multifactorial dyslipidaemia causes abnormal lipid levels in children and young people, causing premature cardiovascular disease and increasing the risk of death, because it can be raised
The prevalence of familial hypercholesterolemia in children and adolescents in the United States is low, at 0.2% to 0.4%, but the prevalence of multifactorial dyslipidemia is reported to be between 7.1% and 9.4%, which is higher than familial hypercholesterolemia.
As screening for lipid disorders can confirm familial hypercholesterolemia, medical staff are considering whether to recommend the test for children and young people.
Accordingly, the USPSTF is involved in screening tests to identify lipid disorders caused by environmental factors such as obesity or a sedentary lifestyle or genetic mutations such as familial hypercholesterolemia, in order to clarify whether screening for lipid disorders in children is necessary and the asymptomatic adolescent under age. of 20. We reviewed 272 papers and over 7000 abstracts.
As a result, the USPSTF concluded that there is insufficient evidence to evaluate the benefits and risks of screening for lipid disorders (Recommendation Level I).
Regarding the accuracy and risk of screening, it was reported that no studies involving confirmatory lipid or genetic testing have been conducted. The evidence was limited to the frequency rather than the diagnostic yield of screening tests to identify familial hypercholesterolemia or multifactorial dyslipidaemia.
In addition, in terms of the benefits of screening and early treatment, whether screening for familial hypercholesterolemia or multifactorial dyslipidemia in children and young people slows cardiovascular events or death or directly improves serum lipid levels or markers of atherosclerosis. the conclusion that no studies had been evaluated.
In addition, the risk of familial hypercholesterolemia or multifactorial dyslipidemia screening in children and young people has not been reported.
Subsequently, the USPSTF recommended comprehensive and intensive behavioral interventions to screen for obesity and control weight in children and youth aged 6 years and older (grade of recommendation B). However, it was concluded that there was insufficient evidence to decide whether screening for hypertension should be performed from childhood or adolescence to prevent cardiovascular disease during adolescence or adulthood (grade I recommendation).
Research is needed to see if screening tests improve cardiovascular health in adulthood
“This recommendation calls for more research to see if screening tests for hypercholesterolemia in children and adolescents improves cardiovascular health in adulthood,” the USPSTF said.
Accordingly, the USPSTF has proposed a long-term study to determine the need for lipid disorder screening in children and adolescents.
First, he suggested that a long-term effectiveness study should be conducted to confirm whether early cardiovascular events or death as adults are prevented when children and young people are screened for a lipid disorder.
Subsequently, lipid disorder screening diagnosis through lipid and genetic testing to identify children and young people with familial hypercholesterolemia or multifactorial dyslipidemia, and the greatest benefit to children and young people diagnosed with familial hypercholesterolemia or multifactorial dyslipidemia To achieve this, we proposed: a study to confirm the optimal age for starting lipid-lowering drug treatment.
He also noted the need for data on the long-term risks of screening and treatment.
Professor Donahue said, “Despite the lack of evidence for screening for lipid disorders, evidence-based management strategies, including obesity screening and counseling, are recommended to improve heart health in young patients. “It starts with, and by doing so, you can improve your cardiovascular health for life.”
Meanwhile, in 2018, the American Heart Association (AHA) recommended that screening for general lipid disorders be performed at least once between ages 9 and 11 and again between ages 17 and 21. The US National Heart, Lung and Blood Institute also made similar recommendations to the AHA.
