Universal Cholesterol Screening in Childhood: A Systematic Review.

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.