Overly Aggressive New Guidelines for Lipid Screening in Children: Evidence of a Broken Process

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* Abbreviations: CVD — : cardiovascular disease NHLBI — : National Heart Lung and Blood Institute A new expert panel report1 released by the National Heart Lung and Blood Institute (NHLBI) and endorsed by the American Academy of Pediatrics2 recommends universal screening of 9- to 11-year-old children with a nonfasting lipid panel and targeted screening of 2- to 8-year-old and 12- to 16-year-old children with 2 fasting lipid profiles. These guidelines were developed in parallel with adult guidelines due out later this year, using what are described as “state-of-the art principles of evidence-based medicine.”3 The process is designed with the laudable intentions of improving transparency, keeping recommendations closely tied to the evidence, and indicating where evidence is strong and where guidelines are based on expert opinion. However, we believe that the high evidence grades for the extremely aggressive pediatric lipid recommendations are inaccurate and unjustified and that the conflicts of interest reported by panel members are too substantial to ignore. In short, these guidelines provide evidence that the NHLBI’s new “evidence-based” guideline process did not achieve its goals. The guidelines we examine here are related to lipid screening, but similar concerns apply to screening children for hypertension discussed in the same NHLBI report.1 Many of our concerns are discussed in Chapter 3 of this report, which was omitted from the supplement published in Pediatrics 2 and appears to have been ignored by the subcommittee that drafted the lipid screening recommendations. Two recent commentaries in JAMA complement our concerns as to the wisdom and appropriateness of these pediatric lipid screening guidelines.4,5 The NHLBI screening recommendations are overly aggressive. The 2- to 8-year-old and 12- to 16-year-old children for whom the panel strongly recommends 2 fasting lipid panels are those who have diabetes, hypertension, or a BMI above the 95th percentile; who smoke cigarettes; who have a parent with a total … Address correspondence to Thomas B. Newman, MD, MPH, Department of Epidemiology and Biostatistics, UCSF Box 0560, San Francisco, CA 94143. E-mail: newman{at}epi.ucsf.edu