Pediatricians missing opportunities to head off heart problems

Despite being one of the most efficient ways to screen for heart-disease risk in all age groups, tests for levels of low-density lipoprotein (LDL) cholesterol are inadequate in young adults, according to a new study published in the Annals of Family Medicine.

Of the 2,587 patients in the study (men 20 to 35 years old and women 20 to 45), fewer than 50 percent had been screened. However, 59 percent of them had heart disease or related conditions such as diabetes or at least one risk factor for heart disease.

"This is a big problem," said lead author Dr. Elena Kuklina, a fellow at the CDC's division of heart disease and stroke prevention. "Heart disease and risk factors are common in young adults, and yet screening rates are low."

The statistics may be rooted in physicians' uncertainty over which of two sets of guidelines to follow: the National Cholesterol Education Program's (NCEP) recommendation to screen young adults, regardless of risk level, every five years once they turn 20; or the U.S. Preventive Services Task Force's advice to screen men younger than 35 and women under 45 only if a person already has heart disease or at least one risk factor.

Both sets of guidelines need to be updated to reflect current knowledge, experts say. The NCEP children's guidelines, for example, were written in 1992, and are based only on family history, which not every person is aware of, and do not take into account risk factors such as obesity and high blood pressure, which are far more prevalent in children today.

Indeed, capturing a child's family history of such problems represents another problem in itself, according to another study published in the Journal of Paediatrics and Child Health. The study revealed that only one-third of pediatric patients diagnosed with obesity who had a relevant family history related to the condition had this information entered into their chart before the diagnosis. The results, obtained by reviewing electronic medical records of children who were diagnosed with obesity and high blood pressure at MetroHealth Medical Center in Ohio, also showed that only 14 percent of children diagnosed with high blood pressure had the relevant family history documented pre-diagnosis.

"That's like asking a woman who has just received an abnormal mammogram result if her mother or sisters had breast cancer, too," lead author Dr. David Kaelber, internist and pediatrician at MetroHealth and chief medical informatics officer, told the Cleveland Plain Dealer.

To improve early detection of heart trouble in kids, the American Academy of Pediatrics issued broader guidelines in 2008 that recommend--in addition to testing LDL levels in kids with a family history of heart disease--screening children whose family history isn't known or who have other heart disease risk factors such as obesity, high blood pressure or diabetes. Screenings should take place after age two but before age 10, the academy said.

To learn more:
- read this article in the Plain Dealer
- see the study abstract in the Journal of Paediatrics and Child Health
- check out this piece in the Los Angeles Times
- find the abstract in the Annals of Family Medicine