Screening children for hyperlipidemia by primary care physicians in West Virginia

Hyperlipidemia is a well known risk factor for coronary artery disease. Several studies have shown that the initial stages of atherosclerosis, one of the major manifestations of hyperlipidemia, may be present as early as age two. Despite this known risk, screening children for hyperlipidemia is sporadic at best. In 2008, the American Academy of Pediatrics (AAP) published a policy update with regards to recommendations for screening children for hyperlipidemia. The crux of the recommendation is to obtain a fasting lipid panel on children between the ages of two and ten with a known family history of hyperlipidemia, known traditional risk factors for cardiovascular disease (including a family history of premature CAD), and/or an unknown family history. This study was undertaken to assess the current practices of family practitioners and pediatricians in West Virginia with regards to screening for hyperlipidemia in children after the policy update.

A thirteen item survey consisting of demographic questions and questions focusing on screening children for hyperlipidemia was constructed, pilot tested, and then distributed to practicing family practitioners and pediatricians all throughout West Virginia. A total of 178 family practitioners and 104 pediatricians returned a completed survey. The data was analyzed with regard to screening practices in general, as well as differences in screening related to practitioner type.

Of the total sample of practitioners (n = 282), 42% routinely offered screening for hyperlipidemia to children between the ages of two and ten with any known traditional risk factors for cardiovascular disease. Pediatricians were statistically more likely to routinely offer screening according to the AAP guidelines than family practitioners. Additionally, 28% of the sample offered screening to children between the ages of two and ten with only a positive family history of hyperlipidemia. 40% of the sample was familiar with the new AAP policy update.

A minority of sampled practitioners offered screening for hyperlipidemia to children in concordance with the 2008 policy statement published by the AAP. This result may stem from lack of knowledge regarding the AAP guideline or the persistence of conflicting viewpoints regarding screening children for hyperlipidemia in general.