Counterpoint: The evidence does not support universal screening and treatment in children.

  title={Counterpoint: The evidence does not support universal screening and treatment in children.},
  author={Peter F. Belamarich},
  journal={Journal of clinical lipidology},
  volume={9 5 Suppl},
  • P. Belamarich
  • Published 1 September 2015
  • Medicine
  • Journal of clinical lipidology
Few pediatric guidelines have generated the amount or intensity of controversy that the pediatric lipid guidelines have. In the following article, I will synthesize the arguments against universal lipid screening and treatment in childhood. Direct evidence that relates the presence of cardiovascular risk factors in childhood to cardiovascular disease outcomes in adulthood is unavailable, and as a consequence, the guidelines were formulated based on a chain of indirect evidence. The debate… 
5 Citations
Lipid Screening in Children: Low-Value Care.
The lack of evidence that the benefits of screening and intervention in children will exceed harms and costs has been highlighted, and the wide discrepancy between Institute of Medicine recommendations for managing conflicts of interest on guideline panels and the extensive industry ties of the authors of the NHLBI guidelines is noted.
Statin Use and the Risk of Type 2 Diabetes Mellitus in Children and Adolescents.
Physicians and patients need to weigh the possible risk of T2DM against the long-term benefits of statin therapy at a young age by weighing the possible risks and benefits of treatment in this population of children with and without a dyslipidemia.
Adverse drug reactions of statins in children and adolescents: a descriptive analysis from VigiBase, the WHO global database of individual case safety reports
This study identified rare but serious safety issues (rhabdomyolysis, myalgia, and hepatocellular injury) that can impact quality of life or lead to life‐threatening complications in children and recommended promotion to pharmacovigilance networks.
Dyslipidemia in children as a risk factor for cardiovascular diseases
It is suggested that the lipid parameters must be carefully monitored beginning from the age of 2 years to facilitate early diagnosis of any imbalances that cause atherosclerosis and take appropriate preventive measures against related diseases that may arise from an early age.
Is it time to get serious about cholesterol screening?


Is universal pediatric lipid screening justified?
An increasing number of these shorter-term studies provide support for the potential benefits of routine pediatric lipid screening to detect and treat children with elevated levels of low-density lipoprotein cholesterol (LDL-C).
The anatomy of a US Preventive Services Task Force Recommendation: lipid screening for children and adolescents.
This article details the approach used by the US Preventive Services Task Force to issue recommendation statements, using the 2007 recommendation for screening of lipid levels as an example, and discusses the contrasting approach to the development of this guideline.
Overly Aggressive New Guidelines for Lipid Screening in Children: Evidence of a Broken Process
These guidelines provide evidence that the NHLBI’s new “evidence-based” guideline process did not achieve its goals and provide concerns as to the wisdom and appropriateness of these pediatric lipid screening guidelines.
Screening for Lipid Disorders in Children: US Preventive Services Task Force Recommendation Statement
The US Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against routine screening for lipid disorders in infants, children, adolescents, or
Pediatric Dyslipidemia: Recommendations for Clinical Management
A review of comprehensive guidelines summarizing the current evidence and providing developmentally appropriate recommendations for screening, treatment, and follow-up of children and adults younger than 21 years at risk for premature CVDs such as myocardial infarction and stroke serves to create awareness among healthcare providers, elected officials, and the lay public about the burden of CVD and the opportunity for prevention.
Cholesterol testing among children and adolescents during health visits.
The National Ambulatory Medical Care Survey (NAMCS) was used to examine rates and correlates of testing and trends in testing, including before and after the 2007 USPSTF and 2008 AAP cholesterol statements.
Application of Pediatric and Adult Guidelines for Treatment of Lipid Levels Among US Adolescents Transitioning to Young Adulthood.
Application of pediatric vs adult guidelines for lipid levels, which consider additional cardiovascular risk factors beyond age and LDL-C concentration, might result in statin treatment for more than 400 000 additional adolescents and young adults.
Integrated guidance on the care of familial hypercholesterolemia from the International FH Foundation.
Recommendations focus on the detection, diagnosis, assessment, and management of FH in adults and children and set guidelines for clinical purposes, based on risk stratification, management of noncholesterol risk factors, and the safe and effective use of low-density lipoprotein-lowering therapies.
A Systematic Review and Meta-Analysis of Statin Therapy in Children With Familial Hypercholesterolemia
The results support the notion that statin therapy in children with HeFH is safe, and even though further studies are required to assess lifelong safety, statin treatment should be considered for all children aged 8 to 18 with HeHF.
The Use of Statins in Pediatrics: Knowledge Base, Limitations, and Future Directions
The cholesterol hypothesis is reviewed and methods to advance the use of statins in childhood that introduce their potential benefits to those individuals at highest risk for future events are suggested.