Universal Versus Targeted Blood Cholesterol Screening Among Youth: The CARDIAC Project

被引:115
作者
Ritchie, Susan K. [1 ]
Murphy, Emily C. -S. [1 ]
Ice, Christa [1 ]
Cottrell, Lesley A. [1 ]
Minor, Valerie [2 ]
Elliott, Eloise [3 ]
Neal, William [1 ]
机构
[1] W Virginia Univ, Robert C Byrd Hlth Sci Ctr, Dept Pediat, Morgantown, WV 26506 USA
[2] Alderson Broaddus Coll, Sch Nursing, Phillipi, WV USA
[3] W Virginia Univ, Coll Phys Act & Sport Sci, Morgantown, WV 26506 USA
关键词
lipids; cardiovascular disease; genetics; children; DENSITY-LIPOPROTEIN CHOLESTEROL; FAMILIAL HYPERCHOLESTEROLEMIA; CHILDREN; GUIDELINES; CHILDHOOD; EFFICACY; SAFETY;
D O I
10.1542/peds.2009-2546
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
OBJECTIVES: The goal was to determine the sensitivity and specificity of family history in identifying children with severe or genetic hyperlipidemias in a rural, predominantly white population. METHODS: A total of 20 266 fifth-grade children in West Virginia, from the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project, who completed a family history and fasting lipid profile were used in analyses. The relationship between hyperlipidemia and family history was determined, and the use of family history to predict the need for pharmacologic treatment among children with dyslipidemia was evaluated. RESULTS: A total of 71.4% of children met the National Cholesterol Education Program (NCEP) guidelines for cholesterol screening on the basis of positive family history. Of those, 1204 (8.3%) were considered to have dyslipidemia (low-density lipoprotein >= 130 mg/dL), and 1.2% of these children with dyslipidemia warranted possible pharmacologic treatment (low-density lipoprotein >= 160 mg/dL). Of the 28.6% who did not have a positive family history (did not meet NCEP guidelines), 548 (9.5%) had dyslipidemia, 1.7% of whom warranted pharmacologic treatment. Sensitivity and specificity data demonstrated that family history does not provide a strong indication as to whether pharmacologic treatment may be warranted. CONCLUSIONS: Results indicate that the use of family history to determine the need for cholesterol screening in children would have (1) missed many with moderate dyslipidemia and (2) failed to detect a substantial number with likely genetic dyslipidemias that would require pharmacologic treatment. The use of universal cholesterol screening would identify all children with severe dyslipidemia, allowing for proper intervention and follow-up and leading to the prevention of future atherosclerotic disease. Pediatrics 2010;126:260-265
引用
收藏
页码:260 / 265
页数:6
相关论文
共 18 条
[1]  
American Academy of Pediatrics. Committee on Nutrition, 1998, Pediatrics, V101, P141
[2]  
[Anonymous], 1993, Arterioscler Thromb, V13, P1291
[3]   Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults [J].
Berenson, GS ;
Srinivasan, SR ;
Bao, WH ;
Newman, WP ;
Tracy, RE ;
Wattigney, WA .
NEW ENGLAND JOURNAL OF MEDICINE, 1998, 338 (23) :1650-1656
[4]  
Daniels SR, 2008, PEDIATRICS, V122, P198, DOI 10.1542/peds.2008-1349
[5]   Efficacy and safety of statin therapy in children with familial hypercholesterolemia -: A randomized, double-blind, placebo-controlled trial with simvastatin [J].
de Jongh, S ;
Ose, L ;
Szamosi, T ;
Gagné, C ;
Lambert, M ;
Scott, R ;
Perron, P ;
Dobbelaere, D ;
Saborio, M ;
Tuohy, MB ;
Stepanavage, M ;
Sapre, A ;
Gumbiner, B ;
Mercuri, M ;
van Trotsenburg, ASP ;
Bakker, HD ;
Kastelein, JJP .
CIRCULATION, 2002, 106 (17) :2231-2237
[6]  
DENNISON BA, 1994, PEDIATRICS, V94, P296
[7]  
FRIEDEWALD WT, 1972, CLIN CHEM, V18, P499
[8]  
GRIFFIN TC, 1989, PEDIATRICS, V84, P365
[9]  
LANNON CM, 1992, PEDIATRICS, V89, P1159
[10]  
LAUER RM, 1988, PEDIATRICS, V82, P309