Abstract 14136: Lipid Screening and Therapy in Youth: Temporal trends From 2002-2012
Background: The 2011 NHLBI Integrated Pediatric Guidelines for cardiovascular risk reduction advocate universal lipid screening to get treatment to the 0.2% of children with familial hypercholesterolemia (FH) who are at-risk for premature coronary events. Critics argue that an increasing proportion of youth with lifestyle-related dyslipidemia could inappropriately receive drug treatment. Given the absence of data, we examined real-world lipid lowering treatment (LLT) and screening trends in youth from 2002 to 2012.
Methods: Using data definitions and extraction methods developed for the Cardiovascular Research Network Virtual Data Warehouse, we queried databases from Scott and White Healthcare (Temple, TX) and Henry Ford Health System (Detroit, MI) for youth 2-20 years old. Extracted data included pharmacy claims, ICD-9 diagnoses for dyslipidemias, and laboratory results. We examined temporal trends for LLT, lipid screening, and low density lipoprotein cholesterol (LDL-C) levels.
Results: Of the children enrolled each year (mean 109,160±21,900), the proportion screened for dyslipidemia from 2002 to 2012 increased from 1.72% to 6.71% (p for trend<0.0001). The proportion detected with potential FH (LDL-C >190mg/dL) was 4 to 10-fold lower than the expected FH prevalence of 0.2%. In the selected group where lipids were screened, the proportion with an LDL-C >190 mg/dL decreased over time from 2.45% to 0.67% (p=0.03). The fraction of all youth started on any LLT each year fell from 0.07% to 0.01% (p=0.002) and specifically for statins fell from 0.04% to 0.01% (p=0.004).
Conclusions: In real-world pediatric practice, the use of LLT has decreased over the past decade. While lipid screening has increased, the total proportion of youth screened is small and the detection of FH is 10-25% of expected. The discordance between higher screening rates without detecting more FH may indicate a change in screening triggers used by providers. Future work should better define disparities in lipid screening and treatment including sociodemographic, geographic, and provider characteristics, and assess changes as the 2011 guidelines are implemented.
- © 2013 by American Heart Association, Inc.