The value of screening young adults for dyslipidemia remains unknown because there is still no direct evidence regarding the benefits and harms in this patient population, according to an update of the 2008 U.S. Preventive Services Task Force recommendations on lipid screening, which was published online August 8 in Annals of Internal Medicine.
In 2008, the USPSTF also could find no direct evidence regarding asymptomatic men and women aged 21-39 years, and thus could make no recommendation for or against lipid screening “because of the low likelihood of identifying lipid levels high enough to justify treatment.” Now the organization has undertaken an extensive review of all English-language articles released since then, searching the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, Medline, reference lists, and ClinicalTrials.gov, said Roger Chou, MD, lead author of the update and director of the Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, Portland, and his associates.
Dr. Roger Chou
They were unable to find any randomized trials, cohort studies, or case-control studies comparing lipid screening against no lipid screening, dyslipidemia treatment against no treatment, or immediate against delayed treatment that assessed mortality, cardiovascular outcomes, or harms in this age group.
Some health organizations recommend starting dyslipidemia screening in asymptomatic adults at age 20, while others don’t recommend the practice until age 35-40 for men and age 50 for women. The 2014 American College of Cardiology/American Heart Association guideline on assessing CV risk deems it “reasonable” to assess traditional risk factors including lipids beginning at age 20, Dr. Chou and his associates said (Ann Intern Med. 2016 Aug 8. doi: 10.7326/M16-0946).
However, the potential adverse effects of statin therapy that is initiated in young adulthood and continued for decades haven’t been well studied, they noted.
In addition, some experts advocate lipid screening to identify young adults who have familial hypercholesterolemia. But this condition has such a low prevalence (estimated at only 1 in 500 people), and affected patients have such a low rate of coronary heat disease events before age 40 (approximately 10%) that the potential benefits of screening for this reason are very limited, the investigators added.
This study was supported by the Agency for Healthcare Research and Quality.