Abstract 17652: Application of Pediatric and Adult Lipid Treatment Guidelines to U.S. Adolescents Transitioning to Young Adulthood

Abstract

Introduction: Current pediatric and adult lipid treatment guidelines differ in their approach to pharmacologic treatment of cholesterol in adolescents and young adults. We hypothesized that a greater proportion of young people ages 17-21 would meet criteria for statin treatment under the pediatric guidelines compared to adult guidelines, but that overall eligibility for statin treatment would be low in this age group. Methods: We applied treatment algorithms from the 2011 NHLBI Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents and the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults to participants in the 1999-2011 National Health and Nutrition Examination Surveys who were 17-21 years of age and had an LDL level measured (n=2,652). We extrapolated the results to a population of 11.2 million individuals ages 17-21 years living in the US. Results: Almost 2% of participants (n=50, 1.9%) qualified for statin treatment under the pediatric guidelines, but only 0.7% (n=18) met treatment criteria under the adult guidelines. Participants who met pediatric criteria had lower mean LDL levels but were more likely to have other cardiovascular risk factors, including hypertension, smoking, and obesity (Table 1). Despite the relatively low percentage of participants reaching LDL treatment thresholds under either guideline, 258,816 U.S. young people would be eligible for statin treatment under the pediatric guidelines and 84,651 would be eligible for treatment under the adult guidelines. Conclusions: Providers who care for adolescents transitioning to adulthood are faced with incongruent lipid guidelines. Application of pediatric guidelines, which use a life course approach and consider additional cardiovascular risk factors beyond age, may result in statin treatment for more young people.