NHLBI Integrated Guidelines on Cardiovascular Disease Risk Reduction: Can We Clarify the Controversy about Cholesterol Screening and Treatment in Childhood?

Abstract

On November 15, 2011, the National Heart, Lung, and Blood Institute (NHLBI)12 released the report of its Expert Panel on Integrated Guidelines for Cardiovascular Risk Reduction. The evidence was reviewed and graded in the full document (>400 pages), and recommendations were made on a broad range of relevant topics. The most controversial aspect of this report by far seems to be the guidelines for lipid screening and treatment in children and adolescents. This topic had been addressed in previous statements going back 3 decades, most recently by the American Academy of Pediatrics in 2008, the National Lipid Association in 2011, and the US Preventive Services Task Force report and commentaries in 2007. The controversy in both the scientific literature and the lay press seems to center around whether these new guidelines would increase pharmacotherapy of children and suggests that many are concerned about the advisability of medicating children who have acquired risk related to obesity and lifestyle issues. To better understand the issues surrounding this important topic, we have asked several experts in this and related fields to address some questions on the topic. The experts include a pediatric preventive cardiologist and member of the guideline committee, an epidemiologist and also a member of the guideline committee, a primary care pediatrician, an adult lipidologist, and a pediatric advanced-practice nurse. The recommendation to add universal screening to selective screening is probably the most controversial part of the new NHLBI guidelines on lipids in children. What do you think is the most important potential benefit? What is the most important potential harm? Stephen R. Daniels: The most important benefit from universal screening is better identification of children with genetic dyslipidemia, such as familial hypercholesterolemia. This condition is common (1/500) and is associated with premature cardiovascular disease. This universal approach will also …