Available online 6 March 2024

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Real and imagined challenges have limited pediatric lipid screening

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Implementation science provides opportunities to shrink screening gaps in care

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Creative and collaborative efforts empower partnerships to improve screening

Abstract

Recent guidance by the USPSTF has renewed the debate surrounding the benefits of pediatric lipid screening. This commentary reviews the evolution of the pediatric lipid screening recommendations in the United States, followed by an exploration of real and imagined challenges that prevent optimal cholesterol screening rates in children. Experiences from other countries identify potential facilitators to improving screening and additional barriers. Real challenges substantively prevent the uptake of these guidelines into practice; imagined challenges, such as identifying the best age to screen, are often context-dependent and can also be surmounted. Implementation science provides guidance on overcoming the real barriers, translating evidence-based recommendations into clinical practice, and informing the next wave of solutions to overcome these challenges.

Section snippetsHistory of pediatric lipid screening recommendations

There have been two streams of thought in United States guidelines related to cholesterol screening. In the first, the USPSTF has consistently given cholesterol screening in childhood an incomplete grade, leaving the choice of whether to screen up to the clinician.1,16,17 The second is the sequence of recommendations from the American Academy of Pediatrics (AAP), which has provided support to guidelines sponsored first by the National Heart, Lung, and Blood Institute (NHLBI) of the National

Conclusion

Despite a wealth of evidence demonstrating the pathogenesis of atherosclerosis and the expanding arsenal of lipid-lowering therapies shown to prevent and combat ASCVD, cholesterol screening rates remain low in children. Clinicians today are faced with numerous challenges, both concrete and imagined, that prevent them from acting upon their interest in disease prevention. Implementation science provides a pathway to create acceptable, feasible, and effective strategies to overcome these

CRediT authorship contribution statement

Tyler J. Schubert: Writing – review & editing, Writing – original draft, Methodology, Formal analysis, Data curation, Conceptualization. Samuel S. Gidding: Writing – review & editing, Supervision, Methodology, Funding acquisition, Formal analysis, Data curation, Conceptualization. Laney K. Jones: Supervision, Methodology, Funding acquisition, Formal analysis, Data curation, Conceptualization.

CONFLICT OF INTERESTS

Tyler J. Schubert has nothing to disclose.

Laney K. Jones is a consultant for Novartis.

Samuel S. Gidding is a consultant for Esperion.

AUTHOR CONTRIBUTIONS

TJS, SSG, and LKJ conceived the idea for this short report and TJS wrote the initial draft. SSG and LKJ contributed to the conceptualization and writing of subsequent drafts. All authors read and approved the final manuscript.

ETHICAL APPROVAL

Not required.

USE OF AI AND AI-ASSISTED TECHNOLOGIES STATEMENT

AI or AI-assisted technology has not been used in the preparation of this manuscript.

FUNDING SOURCES

Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number R61HL161775 and R33HL161775 and The Leona M. & Harry B. Helmsley Charitable Trust Grant #2305-06052. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or The Leona M. & Harry B. Helmsley Charitable Trust.

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© 2024 Published by Elsevier Inc. on behalf of National Lipid Association.