Universal Cholesterol Screening of all 9 - 11 year old Children in Community Based Ambulatory Pediatric Clinics

Introduction: In the U.S. and in most Western countries, coronary artery disease (CAD) is theleading cause of death, linked to hypercholesterolemia, especially in familial hypercholesterolemia (FH). Early identification and treatment of children with hypercholesterolemia has been shown to be effective and safe in reducing morbidity and mortality, especially in those with FH. However, few children with FH are currently being identified. Thus, the National Heart, Blood and Lung Institute (NHLBI) issued a guideline recommending universal cholesterol screening (UCS) of all 9 – 11 year old children in November 2011. We report a comparison of the number of 9 - 11 year old children screened for hypercholesterolemia 1 year prior to and 1 year following publication of the NHLBI’s screening guidelines in 5 community-based ambulatory pediatric clinics. Methods: Five (5) community-based ambulatory pediatric clinics (4 hospital affiliated and 1 university affiliated) were recruited for this study, with retrospectively obtained data that was de-identified. Cholesterol screening results 1 year prior to publication of the NHLBI’s screening guidelines acted as the baseline for each clinic. Rates and results of lipid screening performed by each clinic in all 9-11 year old children at the time of scheduled or un-scheduled clinic visits was measured. Results: Of all eligible 9–11 year-old children, 489 (17.1%) were screened 1 year prior to publication of recommendations, and 686 (20.1%) were screened 1 year following publication of recommendations for universal cholesterol screening. Specifically, Clinic 1 increased screening from 24.2% to 32.3%, Clinic 2 decreased screening from 19% to 16.1%, Clinic 3 decreased screening from 14.7% to 11.9%, Clinic 4 increased screening from 23.1% to 28.5%, and Clinic 5 increased screening from 8.8% to 14.3% of target population. Conclusion: There was a significant increase in the rates of lipid screening for the five clinics in our study following publication of the NHLBI’s recommendations for universal cholesterol screening compared to the year previous to recommendations. Given the high prevalence of premature CVD associated with familial hypercholesterolemia, additional strategies are needed to improve screening rates. The ability to identify this vulnerable population creates the opportunity for prevention of future cardiovascular disease by encouraging healthy lifestyles and the use of lipid lowering medication.