Cosmos Study

Few Pediatric Patients Screened for High Lipid Levels Despite Expert Recommendations

June 1, 2023

Team A:Dave Little, MD, MSJoe Deckert, PhD

Team B:Kersten Bartelt, RNJoe McNitt

Key Findings

Pediatric lipid screening is uncommon both in 9–11-year-olds and in 2–8-year-olds with identified cardiovascular risk, despite clinical practice recommendations from an expert panel convened by the National Heart, Lung, and Blood Institute.
Hispanic patients are screened at higher rates than Black and White patients.
Of patients that are screened, about one-third have a high or borderline-high lipid level.

In 2011, an expert panel convened by the National Heart, Lung, and Blood Institute recommended that all children ages 9–11 should be given a lipid screen to identify early signs of potential future cardiovascular disease and atherosclerosis.¹ Additionally, the panel and the American Academy of Pediatrics recommend patients aged 2–8 who have additional risk factors for early cardiovascular disease development should also have a lipid panel.^1,²

Previous studies have shown pediatric lipid screening rates are low but on an upward trajectory. However, most of these studies were limited to a single organization or assessed data only for visits through 2016.^3,4

We evaluated current pediatric cholesterol screening rates by reviewing 165,519 patients aged 2–8 with an identified cardiovascular risk factor that would qualify them for early screening and 237,548 patients aged 9–11. Patients aged 2–8 with an identified risk factor were screened 5.5% of the time. For patients aged 9–11, only 18.8% had a lipid screening test performed. Sensitivity analyses showed similar screening rates across patient sex and social vulnerability indices. There were differences in screening rates by race and ethnicity, with Hispanic patients being screened at the greatest rates, and White patients being screened at the lowest rates.

Figure 1

Pediatric Lipid Screening Rates

Figure 1. Percentage of pediatric patients recommended to have a lipid screening that had a screening completed stratified by race and ethnicity.

Of those who did have a lipid screening completed, 9.3% of the patients aged 9–11 and 13.5% of patients aged 2–8 with a cardiovascular risk factor had high lipid levels identified. Additionally, around one in four patients had a borderline-high lipid level across both groups assessed, as shown in Figure 2. No statistically significant differences in lipid levels were noted between demographic groups.

Figure 2

Elevated Pediatric Lipid Screening Values

Figure 2. Percentage of screened pediatric patients with elevated lipid levels. High lipid values are ≥200 mg/mL, while borderline-high lipid values are from 179-199 mg/mL.

Our findings confirm that pediatric lipid screening rates remain low despite recommendations.

These data come from Cosmos, a HIPAA-defined Limited Data Set of more than 185 million patients from 200 Epic organizations including 1,147 hospitals and more than 25,000 clinics, serving patients in all 50 states and Lebanon. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions.

References

Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011;128 Suppl 5(Suppl 5):S213-S256. doi:10.1542/peds.2009-2107C
Howard T, Grosel J. Updated guidelines for lipid screening in children and adolescents. JAAPA. 2015;28(3):30-36. doi:10.1097/01.JAA.0000460916.60015.88
Berger JH, Chen F, Faerber JA, O’Byrne ML, Brothers JA. Adherence with lipid screening guidelines in standard- and high-risk children and adolescents. Am Heart J. 2021;232:39-46. doi:10.1016/j.ahj.2020.10.058
Eichberger L, Kern L, Wang H, Crow J, Rhee KE. Universal Lipid Screening Among 9- to 11-Year-Old Children: Screening Results and Physician Management. Clin Pediatr (Phila). 2022;61(3):280-288. doi:10.1177/00099228221075409