title: Cholesterol Screening and Treatment Practices and Preferences: A Survey of United States Pediatricians.
abstract: To determine pediatricians' practices, attitudes, and barriers regarding screening for and treatment of pediatric dyslipidemias in 9- to 11-year-olds and 17- to 21-year-olds.
  
  
  
  American Academy of Pediatrics (AAP) 2013-2014 Periodic Survey of a national, randomly selected sample of 1627 practicing AAP physicians. Pediatricians' responses were described and modeled.
  
  
  
  Of 614 (38%) respondents who met eligibility criteria, less than half (46%) were moderately/very knowledgeable about the 2008 AAP cholesterol statement; fewer were well-informed about 2011 National Heart, Lung, and Blood Institute Guidelines or 2007 US Preventive Service Task Force review (both 26%). Despite published recommendations, universal screening was not routine: 68% reported they never/rarely/sometimes screened healthy 9- to 11-year-olds. In contrast, more providers usually/most/all of the time screened based on family cardiovascular history (61%) and obesity (82%). Screening 17- to 21-year-olds was more common in all categories (P?<?.001). Only 58% agreed with universal screening, and 23% felt screening was low priority. Pediatricians uniformly provided lifestyle counseling but access to healthy food (81%), exercise (83%), and adherence to lifestyle recommendations (96%) were reported barriers. One-half of pediatricians (55%) reported a lack of local subspecialists. Although 62% and 89% believed statins were appropriate for children and adolescents with high low-density lipoprotein cholesterol (200?mg/dL) unresponsive to lifestyle, a minority initiated statins (8%, 21%).
  
  
  
  US pediatricians report lipid screening and treatment practices that are largely at odds with existing recommendations, likely because of lack of knowledge and conflicts among national guidelines, and concern about treatment efficacy and harms. Education regarding pediatric lipid disorders could promote guideline implementation.
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA. Electronic address: sarah.deferranti@cardio.chboston.org.
authors.forename: Sarah D
authors.initials: SD
authors.lastname: de Ferranti
authors.affiliation: Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Departments of Medicine and Pediatrics, Tufts University School of Medicine, Boston, MA.
authors.forename: Angie Mae
authors.initials: AM
authors.lastname: Rodday
authors.affiliation: Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Departments of Medicine and Pediatrics, Tufts University School of Medicine, Boston, MA.
authors.forename: Susan K
authors.initials: SK
authors.lastname: Parsons
authors.affiliation: Department of Research, American Academy of Pediatrics, Elk Grove Village, IL.
authors.forename: William L
authors.initials: WL
authors.lastname: Cull
authors.affiliation: Department of Research, American Academy of Pediatrics, Elk Grove Village, IL.
authors.forename: Karen G
authors.initials: KG
authors.lastname: O'Connor
authors.affiliation: Department of Pediatrics, Children's Hospital Colorado, Denver, CO.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Daniels
authors.affiliation: Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Departments of Medicine and Pediatrics, Tufts University School of Medicine, Boston, MA; American Board of Pediatrics, Chapel Hill, NC.
authors.forename: Laurel K
authors.initials: LK
authors.lastname: Leslie
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D003376:Counseling / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D050171:Dyslipidemias / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008019:Life Style; D008055:Lipids / Q000097:blood; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D000072143:Pediatricians; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids
keywords: adolescent; child