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Experts Criticize Lipid Screening Guidelines for Children

In addition, the recommendations are based on expert opinion rather than on solid evidence, the researchers said, which is problematic since the guidelines’ authors disclosed extensive potential conflicts of interest.

The guidelines were written by a panel assembled by the National Heart, Lung and Blood Institute and were published in Pediatrics in November 2011. They also were endorsed by the American Academy of Pediatrics.

The guidelines call for universal screening of all 9- to 11-year-old children with a non-fasting lipid panel, and for targeted screening of 30% to 40% of 2- to 8-year-old and 12- to 16-year old children with two fasting lipid profiles. Previous guidelines recommended only that children considered at high risk of elevated levels should be screened with a simple non-fasting total cholesterol test.

The call for a dramatic increase in lipid screening has the potential to transform millions of healthy children into patients labeled with so-called dyslipidemia, according to the commentary by Thomas Newman, MD, MPH; Mark Pletcher, MD, MPH; and Stephen Hulley, MD, MPH, of the University of California–San Francisco Department of Epidemiology and Biostatistics.

“The panel made no attempt to estimate the magnitude of the health benefits or harms of attaching this diagnosis at this young age,” said Newman. “They acknowledged that costs are important, but then went ahead and made their recommendations without estimating what the cost would be. And it could be billions of dollars."

The authors noted that the panel chair and all members who drafted the lipid screening recommendations disclosed an “extensive assortment of financial relationships with companies making lipid-lowering drugs and lipid-testing instruments." Some of those relevant relationships include paid consultancies or advisory board memberships with pharmaceutical companies that produce cholesterol-lowering drugs, such as Merck, Pfizer, Astra Zeneca, Bristol-Myers Squibb, Roche, and Sankyo.

“The panel states that they reviewed and graded the evidence objectively,” said Newman. “But a recent Institute of Medicine report recommends that experts with conflicts of interest either be excluded from guideline panels, or, if their expertise is considered essential, should have non-voting, non-leadership, minority roles.”

Experts without conflicts of interest are needed to help synthesize the evidence needed to estimate the health benefits, risks, and costs of the proposed interventions, according to Newman. He said that “these recommendations fall so far short of this ideal that we hope they will trigger a re-examination of the process by which they were produced.”

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