Universal Cholesterol Screening in Childhood: A Systematic Review

Abstract

Background: In 2011, a US expert panel recommended universal cholesterol screening for children ages 9 to 11 years. Controversy exists over this recommendation, especially because the most recent systematic review on universal childhood screening was inconclusive.

Objectives: To conduct an updated systematic review on universal cholesterol screening in childhood and effect on health outcomes, clinical management, screening acceptability, and healthcare costs.

Data sources: We searched MedLine, EMBASE, Psychinfo, and the Cochrane Registry of Controlled Trials from October 2005 to January 2016. We added new studies identified to those from the previous systematic review (1966-September 2005).

Study eligibility, participants, and interventions: We included controlled trials, pre-post, cohort, survey, and qualitative studies of universal cholesterol screening in children ages 0 to 18 years.

Study appraisal and synthesis methods: Two independent reviewers assessed abstracts and full-text studies, extracted data, and ranked quality. Cost data were inflation-adjusted to 2015 dollars.

Results: Nine new studies met inclusion criteria, taking the total number of relevant studies to 21. Screening was associated with no change in cholesterol in 1 of 1 study on health outcomes. A positive screen for dyslipidemia was associated with diet and/or exercise changes in 29% to 92% of families in 4 of 4 studies. Adherence with new guidelines for universal screening was low (16%-18%) in 3 of 3 studies. Costs per case of familial hypercholesterolemia detected were $12,500 to $20,300.

Limitations: Included studies were heterogeneous in outcomes.

Conclusions and implications of key findings: Universal cholesterol screening might have small, positive effects on lifestyle change, but the effect on health remains understudied.

Keywords: cardiovascular diseases; dyslipidemias; health care costs; health services research; hypercholesterolemia; mass screening; patient acceptance of health care; pediatrics; primary health care.