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Lipid Management in Youth: What Are the Screening and Treatment Trends Within the Pediatric Cardiovascular Research Network?

Publication Date

4-30-2015

Keywords

lipid management, youth

Abstract

Background/Aims: Atherosclerotic cardiovascular disease (ASCVD) accounts for 1 in every 3 deaths in the United States, and studies show that the precursors of atherosclerosis are apparent early in life. The correlation between childhood cardiovascular risk factors and the extent of atherosclerosis in adulthood has led to the development of guidelines aimed at attenuating ASCVD risks in youth. One major ASCVD risk factor is dyslipidemia, including both familial hypercholesterolemia (FH) and lifestyle-related hyperlipidemia. Currently, few studies have investigated temporal lipid screening and treatment trends in youth and guideline adherence before and after the 2011 update, which includes universal lipid screening and targeted screening recommendations. The purpose of this study is to identify lipid screening and treatment trends and guideline adherence in a diverse population of children and adolescents across multiple health care systems participating in the Pediatric Cardiovascular Risk Network (P-CVRN) study. This data is also essential to provide up-to-date cost-effective analyses (CEA).

Methods: Institutional Review Board approval was obtained for this study. This retrospective database study includes > 600,000 youth age 2 to 21 years with at least one outpatient visit captured across five P-CVRN sites between 2001 and 2013. The following de-identified data was captured and extracted at an individual patient level from inpatient and outpatient claims data: patient demographics, diagnoses, pretreatment laboratory values, initial lipid-lowering medications and doses, initial posttreatment laboratory values and presence of other risk factors or conditions.

Results: The data collected was used to analyze trends in pediatric lipid management and inform contemporaneous CEA related to pediatric lipid screening and treatment. Our data revealed that screening rates declined at most sites and varied from a peak of ~25% to a low of ~5% of youth. Lipid-lowering medications were prescribed in 0.02–0.19% of all youth, and prescribing did not generally increase over time. Lipid-lowering medication and dose initiation, pre- and posttreatment laboratory values, and medication possession ratio were analyzed using logistic regression. CEA did not support the benefit of universal lipid screening in youth.

Discussion: Current screening trends indicate that health care providers are nonadherent with guideline recommendations, and CEA reveals that universal screening in youth is not cost-effective.

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Submitted

March 30th, 2015

Accepted

April 28th, 2015