Cholesterol Screening and Management in Children and Young Adults Should Start Early—NO!

Abstract

In 2011, an expert panel from the National Heart, Lung, and Blood Institute released recommendations for universal lipid screening and treatment of high cholesterol in children. There is no evidence that universal screening will help children lead longer, healthier lives. These recommendations will, however, fuel the epidemic of overtreatment that is currently threatening our healthcare system and our patients. The Epidemic Universal lipid screening and management in children and young adults will be of no clear benefit, and threatens to fuel a concerning but under-recognized epidemic threatening our health system right now: overtreatment. At a time when healthcare is central to discussions about the perilous state of our economy, this epidemic of overuse is costing the United States an estimated $200 billion per year, 1 and often leads to gross violation of the most fundamental tenet of healthcare: primum non nocere. Substantial harm has resulted from public health errors involving overdiagnosis and overtreatment, such as prostate cancer screening in men and hormone replacement therapy for postmenopausal women. Countless healthy men have undergone unnecessary treatment for prostate cancer, 2 and healthy women have suffered from heart disease, stroke, and breast cancer 3 directly as a result of our well-intentioned but misguided medical interventions. These examples represent mistakes made from the misinterpretation of numerous studies that were fraught with bias. The Victims Yet, here we are again, ready to embrace a potentially harmful and costly screening test for which there is The authors have no funding, financial relationships, or conflicts of interest to disclose.

Factors Affecting Children’s Cholesterol Levels with a View to Prevent Cardiovascular Disease—The Unique Benefits of Health Screening at the Elementary School

“…Multiple regression analyses were performed with the logarithmic value of cholesterol levels as a response variable, awareness about lifestyles and health of children as an explanatory variable, and child's sex and BMI as moderating variables. Sex and BMI were used as moderating variables for LDL cholesterol, as the LDL cholesterol level differs between the sexes [18] and is strongly associated with BMI [19]. Using a large number of questions on lifestyles, the step-down procedure was applied in multiple regression analyses to narrow down relevant lifestyle variables.…”

“…Identifying dyslipidemia in children through screening leads to preventing the increase of CVD risk. Screening is highly significant, especially for identifying familial dyslipidemia, which is known to affect one in five hundred people [19] [21] [22] [23]. Therefore, an increase in the screening rate would greatly contribute to prevention efforts [23].…”

Overdiagnosis: How Our Compulsion for Diagnosis May Be Harming Children

“…[97][98][99] Hypoxemia in bronchiolitis Hospital admissions for children with bronchiolitis have significantly increased since 1980, a period coinciding with increased use of pulse oximetry, yet mortality from bronchiolitis during the same time period has been unchanged. 13,100 Oxygen saturation changes as small as 2% significantly increase a physician' s decision for admission, and the diagnosis of hypoxemia by continuous pulse oximetry prolongs hospitalization, but there is no evidence that supplemental oxygen for transient desaturations benefits children.…”

Does true Gleason pattern 3 merit its cancer descriptor?

“…Keeping in mind previous adaptations in other genitourinary cancer, the loss of the cancer terminology for pure Gleason 84 . Now, evidence is emerging that instigating treatment modalities for the new diagnoses of these diseases is failing to reduce morbidity and mortality [85][86][87] .…”