Re: Screening for Lipid Disorders in Children -- Recommendation Statement of the U.S. Preventive Services Task Force
- From: MarilynMann <mannm@xxxxxxxxxxx>
- Date: Fri, 13 Jul 2007 10:55:52 -0700
On Jul 13, 12:42 pm, William Wagner <-----william...@xxxxxxxxx> wrote:
http://www.ahcpr.gov/clinic/uspstf07/chlipid/chlipidrs.htm
Good !
However not everyone thinks like that.
http://content.onlinejacc.org/cgi/content/full/40/12/2122
With respect to the screening issue, see the following: Drug Therapy
of High-Risk Lipid Abnormalities in Children and Adolescents: A
Scientific Statement From the American Heart Association
Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council
of Cardiovascular Disease in the Young, With the Council on
Cardiovascular Nursing,
http://circ.ahajournals.org/cgi/content/full/115/14/1948
I note that Dr. Brian McCrindle, chairman of the writing group, has
ties to Schering-Plough, AstraZeneca, Sankyo and Merck, a circumstance
that to me does not seem ideal.
There are many difficult issues here. With respect to screening,
pediatricians do not routinely order fasting lipid profiles for kids,
unless they have some reason to do so. Some do non-fasting TC tests
routinely, but these tests do not have high sensitivity for detecting
even high-risk kids such as kids with familial hypercholesterolemia,
except in cases where it is already known that one of the parents has
FH. Information on family history is often lacking. And so
forth.
Bill who likes
http://www.ti.ubc.ca/node/52
For high-risk kids, I do not know that these primary prevention trials
really tell us much. Depending on how the revised AHA guidelines are
applied, however, some kids who are intermediate risk, or whose risk
is really not known, might be treated with statins. The cutpoints
are
LDL > 190
LDL > 160 with family history of early CVD or at least 2 risk factors
lower LDL (unspecified) with additional risk factors (they list
everything they can think of here, including "strong" family history
(undefined), smoking or passive smoke exposure, associated low HDL,
high TG and small dense LDL, MS, diabetes, organ transplantation,
survivors of childhood cancer, HIV infection, hypertension, "novel and
emerging risk factors and markers, e.g., elevated lipoprotein(a),
homocysteine, C-reactive protein," etc.)
The guidelines recommend screening for kids with family history or
overweight/obesity and recommend statins as first-line treatment.
With respect to teenage girls, they state "[c]ounsel adolescent
females about statin contraindications in pregnancy and the need for
abstinence or use of appropriate contraceptive measures. Seek
referral to an adolescent medicine or gynecologic specialist as
appropriate." I see some problems with this . . .
I don't know how many pediatricians are going to try to apply these
guidelines, but I think those that do may find it difficult.
Marilyn
.
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