Temporal trends in lipid screening and therapy among youth from 2002 to 2012.
BACKGROUND
Pediatric lipid management recommendations have evolved from selective screening to universal screening to identify and target therapy for genetic dyslipidemias. Data on the success of the selective screening guidelines for lipid testing, dyslipidemia detection, and lipid management are conflicting.


OBJECTIVE
To determine temporal trends in lipid testing, dyslipidemia categories and pharmacotherapy in a cohort of 653,642 individual youth aged 2 to 20 years from 2002 to 2012.


METHODS
Summary data on lipid test results, lipid-lowering medicine (LLM) dispensings, and International Classification of Diseases, Ninth Revision diagnoses were compiled from the virtual data warehouses of 5 sites in the Cardiovascular Research Network. Temporal trends were determined using linear regression.


RESULTS
Among the average 255,160 ± 25,506 children enrolled each year, lipid testing declined from 16% in 2002 to 11% in 2012 (P < .001 for trend). Among the entire population, the proportion newly detected each year with low-density lipoprotein cholesterol >190 mg/dL, a value commonly used to define familial hypercholesterolemia, increased over time from 0.03% to 0.06% (P = .03 for trend). There was no significant change over time in the proportion of the yearly population initiated on LLM or statins specifically (0.045 ± 0.009%, P = .59 [LLM] and 0.028 ± 0.006%, P = .25 [statin]).


CONCLUSIONS
Although lipid testing declined during 2002 to 2012, the detection of familial hypercholesterolemia-level low-density lipoprotein cholesterol increased. Despite this increased detection, pharmacotherapy did not increase over time. These findings highlight the need to enhance lipid screening and management strategies in high-risk youth.
Lillie Frank Abercrombie Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA. Electronic address: Justin.zachariah@bcm.edu.
Justin P
JP
Zachariah
Department of Pediatrics, Baylor Scott & White Health, Temple, TX, USA; Department of Internal Medicine, Baylor Scott & White Health, Temple, TX, USA.
Catherine J
CJ
McNeal
Center for Applied Health Research, Baylor Scott & White Health, Temple, TX, USA; Center for Applied Health Research, Department of Internal Medicine, Central Texas Veterans Health Care System, Temple, TX, USA.
Laurel A
LA
Copeland
Center for Applied Health Research, Baylor Scott & White Health, Temple, TX, USA; Center for Applied Health Research, Department of Internal Medicine, Central Texas Veterans Health Care System, Temple, TX, USA.
Ying
Y
Fang-Hollingsworth
Center for Applied Health Research, Baylor Scott & White Health, Temple, TX, USA; Center for Applied Health Research, Department of Internal Medicine, Central Texas Veterans Health Care System, Temple, TX, USA.
Eileen M
EM
Stock
Center for Applied Health Research, Baylor Scott & White Health, Temple, TX, USA; Center for Applied Health Research, Department of Internal Medicine, Central Texas Veterans Health Care System, Temple, TX, USA.
FangFang
F
Sun
Department of Statistical Sciences, Baylor University, Waco, TX, USA.
Joon Jin
JJ
Song
Department of Health Policy and Management, College of Public Health, University of South Florida, Tampa, FL, USA.
Sean T
ST
Gregory
Kaiser Permanente Center for Health Research Hawaii, Honolulu, HI, USA.
Jeffrey O
JO
Tom
Geisinger Center for Health Research, Danville, PA, USA; Department of Pharmacy Practice, Wilkes University, Wilkes-Barre, PA, USA.
Eric A
EA
Wright
Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, Marshfield, WI, USA.
Jeffrey J
JJ
VanWormer
Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA.
Andrea E
AE
Cassidy-Bushrow
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003710:Demography; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D015994:Incidence; D008055:Lipids / Q000097:blood*; D008297:Male; D008403:Mass Screening; D015995:Prevalence; D013997:Time Factors; D055815:Young Adult
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D008055:Lipids
ASCVD; Dyslipidemia; Epidemiology; Familial hypercholesterolemia; Lipid testing; Statin therapy; Youth