Current guidelines on screening, diagnosis and management of dyslipidaemia in childhood: a systematic review
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Bernadeta Patro-Golab1,2,3, Thu Giang Le Thi4,5,6, Anna M Litwin4,5,6
1Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, Munich, Germany. bernadeta.patrogolab@med.uni-muenchen.de.
Insights
Early identification of childhood lipid disorders is key for cardiovascular health. Current guidelines consistently recommend statins for familial hypercholesterolemia but lack consensus on universal screening methods.
Area of Science:
- Pediatric Cardiology
- Public Health
- Clinical Practice Guidelines
Background:
- Lipid disorders in children require early identification and treatment to improve long-term cardiovascular health.
- Systematic review of existing guidelines on screening, diagnosis, and management of dyslipidemias in pediatric populations.
Purpose of the Study:
- To systematically review and analyze current international guidelines on the screening, diagnosis, and management of dyslipidemias in children.
- To identify consensus and discrepancies in recommendations, particularly regarding universal screening strategies for early detection of lipid disorders.
Main Methods:
- Systematic literature search of Medline, Embase, and relevant websites for clinical practice guidelines published between January 2018 and January 2025.
- Quality assessment of included guidelines using the AGREE II tool.
Main Results:
- Six national guidelines, primarily focused on familial hypercholesterolemia (FH), were included.
- Recommendations for universal childhood dyslipidemia screening varied significantly, from insufficient evidence to moderate support.
- Statins are consistently recommended as first-line therapy for pediatric FH, with behavioral interventions strongly advised for FH and obesity-related dyslipidemia.
Conclusions:
- Current guidelines show consistency in managing pediatric dyslipidemias, especially regarding pharmacotherapy for FH.
- A significant lack of consensus exists on universal screening protocols for early detection of lipid disorders in children.
- Further consensus is needed to establish optimal strategies for identifying and managing pediatric lipid disorders.
Background:
Early identification and treatment of lipid disorders has the potential to improve long-term cardiovascular health in affected individuals. We performed a systematic review of guidelines on screening, diagnosis, and management of dyslipidaemias in children.
Methods:
We searched Medline, Embase, and selected websites for relevant clinical practice recommendations/guidelines, published in English/German from 01.01.2018 to 31.01.2025. We used AGREE II tool to assess guidelines' quality.
Results:
Six national guidelines, mainly on familial hypercholesterolemia (FH), were included. Recommendations for universal screening for dyslipidaemias in childhood differed, ranging from the statement of insufficient evidence (n = 1) or negative recommendation of the national screening committee (n = 1) through weak (n = 2) to moderate (n = 1) recommendations to consider population screening. All organizations recommended statins as a first-line drug therapy in children with FH (strong recommendation). Behavioral intervention was mainly strongly recommended as an additional treatment component of FH, and as therapy of choice in childhood obesity related dyslipidaemia. Guidelines applied different systems to categorize certainty of evidence and strength of recommendations. 50% of guidelines scored high (>70%) for rigor of development.
Conclusions:
Current guidelines provide overall consistent recommendations for the management of childhood dyslipidaemias, but show lack of consensus regarding universal screening for early detection of lipid disorders.
Impact:
Health behavior counseling is recommended for all children affected with dyslipidaemia. Statins are consistently proposed as a first-line drug therapy in pediatric familial hypercholesterolemia. Recommendations for universal screening for dyslipidaemias in childhood vary. This systematic review provides insights into current recommendations on pediatric lipid disorders, explores potential reasons for discrepancies, and indicates the need for consensus on the optimal strategy for early identification of familial hypercholesterolemia.
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