This is the current release of the guideline.

Note from the U.S. Preventive Services Task Force (USPSTF): The USPSTF is redesigning its recommendation statement in response to feedback from primary care clinicians. The USPSTF released, in July 2007, a new, updated recommendation statement format that is easier to read and incorporates advances in USPSTF methodology. The recommendation statement below is in an interim format that combines existing with new language and elements. Although the definitions of grades remain the same, other elements have been revised.

The U.S. Preventive Services Task Force (USPSTF) grades its recommendations (A, B, C, D, or I) and the quality of the overall evidence for a service (good, fair, poor). The definitions of these grades can be found at the end of the "Major Recommendations" field.

Summary of Recommendations

The USPSTF concludes that the evidence is insufficient to recommend for or against routine screening for lipid disorders in infants, children, adolescents, or young adults (up to age 20). (I recommendation)

Clinical Considerations

• Dyslipidemias are abnormalities of lipoprotein metabolism and include elevations in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), or triglycerides or deficiencies of high-density lipoprotein cholesterol (HDL-C). These disorders can be acquired or familial; monogenic dyslipidemias are related to genetic conditions such as familial hypercholesterolemia in some individuals. Multifactorial dyslipidemias are due to risk factors including environmental factors (obesity, diet) or currently unidentified genetic factors. This recommendation applies to all asymptomatic individuals from birth to age 20.
• Because abnormal lipid levels have been strongly associated with the risk of coronary heart disease (CHD) events in adulthood, and early identification and lipid-lowering intervention in certain populations of adults can prevent CHD events, much attention has been directed at screening individuals for dyslipidemia at young ages (e.g., childhood). Among children and adolescents, 3 groups may be identified through screening: (1) children with undiagnosed monogenic dyslipidemias such as familial hypercholesterolemia; (2) those with undiagnosed secondary causes of dyslipidemia; and (3) those with multi-factorial dyslipidemia (polygenetic or related to risk-factors). However, the clinical health benefits shown in adults identified and treated for dyslipidemia have not been studied in children, making the role of screening children uncertain.
• Children and adolescents with diabetes may be at especially high risk for dyslipidemia and cardiovascular events. Screening children and adolescents with diabetes for dyslipidemia has been recommended by other groups as a part of appropriate care for these children.
• The use of family history as a screening tool for dyslipidemia has variable accuracy largely because definitions of a positive family history and lipid threshold values vary substantially. Screening using family history as defined by the National Cholesterol Education Program (NCEP) and the American Academy of Pediatrics (AAP) has been shown to have high rates of false negative results.
• If clinicians choose to screen for dyslipidemia, the preferred screening tests are TC and HDL-C on nonfasting or fasting samples; calculating LDL-C requires fasting samples.

Other Considerations

• Effectiveness of treatment interventions (diet, exercise, lipid lowering agents) in children with dyslipidemia (including multifactorial dyslipidemia) in improving health outcomes remains a critical research gap. Population-based screening studies or randomized controlled trials (RCTs) following children and adolescents into adulthood after treatment interventions will be necessary to assess universal lipid screening in childhood or adolescence.
• Rising rates of childhood overweight may lead to a higher prevalence of dyslipidemia in childhood and adulthood. Continued tracking of dyslipidemia in all age groups will be important as the epidemiology of obesity evolves.

Definitions:

Strength of Recommendations

The USPSTF grades its recommendations according to one of five classifications (A, B, C, D, I) reflecting the strength of evidence and magnitude of net benefit (benefits minus harms):

A

The USPSTF strongly recommends that clinicians provide [the service] to eligible patients. The USPSTF found good evidence that [the service] improves important health outcomes and concludes that benefits substantially outweigh harms.

B

The USPSTF recommends that clinicians provide [this service] to eligible patients. The USPSTF found at least fair evidence that [the service] improves important health outcomes and concludes that benefits outweigh harms.

C

The USPSTF makes no recommendation for or against routine provision of [the service]. The USPSTF found at least fair evidence that [the service] can improve health outcomes but concludes that the balance of benefits and harms is too close to justify a general recommendation.

D

The USPSTF recommends against routinely providing [the service] to asymptomatic patients. The USPSTF found at least fair evidence that [the service] is ineffective or that harms outweigh benefits.

I

The USPSTF concludes that the evidence is insufficient to recommend for or against routinely providing [the service]. Evidence that the [service] is effective is lacking, of poor quality, or conflicting and the balance of benefits and harms cannot be determined.

Strength of Evidence

The USPSTF grades the quality of the overall evidence for a service on a 3-point scale (good, fair, poor):

Good

Evidence includes consistent results from well-designed, well-conducted studies in representative populations that directly assess effects on health outcomes.

Fair

Evidence is sufficient to determine effects on health outcomes, but the strength of the evidence is limited by the number, quality, or consistency of the individual studies, generalizability to routine practice, or indirect nature of the evidence on health outcomes.

Poor

Evidence is insufficient to assess the effects on health outcomes because of limited number or power of studies, important flaws in their design or conduct, gaps in the chain of evidence, or lack of information on important health outcomes.

None available

The type of evidence supporting the recommendations is identified in the "Major Recommendations" field.

Not applicable: The guideline was not adapted from another source.

2007 Jul 9

United States Preventive Services Task Force - Independent Expert Panel

The U.S. Preventive Services Task Force (USPSTF) is a federally-appointed panel of independent experts. Conclusions of the U.S. Preventive Services Task Force do not necessarily reflect policy of the U.S. Department of Health and Human Services (DHHS) or its agencies.

United States Government

U.S. Preventive Services Task Force (USPSTF)

The U.S. Preventive Services Task Force has an explicit policy concerning conflict of interest. All members disclose at each meeting if they have an important financial conflict for each topic being discussed. Task Force members and EPC staff with conflicts can participate in discussions about evidence, but members abstain from voting on recommendations about the topic in question.

From: Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow, CD, Teutsch SM, Atkins D. Current methods of the U.S. Preventive Services Task Force: a review of the process. Methods Work Group, Third U.S. Preventive Services Task Force. Am J Prev Med 2001 Apr;20(3S):21-35.

This is the current release of the guideline.

This NGC summary was completed by ECRI Institute on September 18, 2007. The information was verified by the guideline developer on October 2, 2007.