Abstract 44: Lipid Screening In Children And Adolescents In Community Practice 2007-2010
Authors: Margolis Karen , Trower Nicole K , Kharbanda Elyse O , Parker Emily D , Adams Kenneth F , Sinaiko Alan R , Sherwood Nancy E , Lo Joan C , Greenspan Louise C , Chandra Malini , Magid David J , Daley Matthew F , Daniels Stephen , Tavel Heather M , O’Connor Patrick J 
Published: July 2021

Background:
A 2011 guideline on cardiovascular risk reduction in children recommended universal screening for dyslipidemia in children at age 9-11 and again at age 17-21.

Objectives:
To ascertain frequency of lipid testing before the guideline was issued in children and adolescents, in predefined age, gender, BMI and race strata.

Methods:
Study subjects included 294,369 individuals age 3-19 years enrolled at HealthPartners (Minnesota), Kaiser Permanente Colorado or Kaiser Permanente Northern California in 2007-2010 and with at least one measurement of blood pressure and a height measurement within 90 days. We excluded children with medical conditions (other than obesity) or medications that could have prompted lipid testing. Subjects’ electronic medical records were examined for date and results of the first recorded measurement of total cholesterol and HDL cholesterol (HDL-C). We report descriptive statistics on the proportion of children who received lipid testing and abnormal test results by age, gender, BMI and race/ethnicity group.

Results:
The study population was 49.9% female, 12.3% Black, 21.0% Hispanic, 11.4% Asian; 15.3% were overweight (BMI percentile 85-<95) and 14.5% were obese (BMI percentile
>
95). Across the 3 sites during the period of observation, 9.7% of youth had at least one lipid screen; rates varied by BMI (5.8% of normal weight, 10.8% of overweight and 27.3% of obese youth). The proportion tested increased steadily with age, ranging from 1.0% of 3-5 year olds, to 8.7% of 9-11 years olds, and to 25.2% of 17-19 year olds. There was relatively little variation in testing by sex and race/ethnicity after adjusting for age and BMI. Among those tested, total cholesterol was elevated (
>
200 mg/dL) in 8.7%, HDL-Cl was low (<40 mg/dL) in 27.5% of boys and in 18.0% of girls, and non-HDL-C was elevated (
>
145 mg/d/L) in 12.0%. The proportion with elevated levels of non-HDL-C was 6.9% in normal weight, 11.5% in overweight and 16.9% of obese children, and was 14.4% in 9-11 year olds and 12.4% in 17-19 year olds.

Conclusion:
Before the 2011 guideline, lipid testing was uncommon in 9-11 year old children, but was performed in one quarter of 17-19 year old adolescents. The high proportion of youth with abnormally low HDL-C likely reflects targeted testing of overweight and obese individuals. The proportion of youth with elevated non-HDL-C is closer to that observed in population-based surveillance studies during the same time period. These data serve as a benchmark for assessing change in practice patterns as the new guideline is implemented for pediatric lipid screening and management. They suggest that health care systems will need to assess their capacity to deliver lifestyle interventions in the substantial proportion of youth for whom such services are recommended.