Excessive blood cholesterol implies a future risk for atherosclerotic thromoeboembolic risk diseases like heart attack and stroke and exacerbate problems related to hypertension and diabetes.
While many will argue no screening is needed or cholesterol testing is useless, which may be right in some ways. But on the contrary cholesterol/lipid are the actual things getting on to the vessels clogging our vessels to give the aforementioned disease processes. The clogged vessels demonstrate that on dissection.
Alongside the incidence of lipidemias is increasing and getting them diagnosed earlier may help reduce the ris either through life intervention or drugs.
Kindly have you say on this
Dear Sir
Greetings
I am very pleased to share this important discussion.
The US Preventive Task Force recommends screening at the age of 35 years in males and 45 years in females, and at 20 years in case of diabetes or cardiovascular risk factors, while the Adult Treatment Panel 111 recommends screening at 20 years of age and to repeat test every 5 years. The cost and insurance coverage may limit adherence to the above guidelines in developing countries.
Hi Sikandar,
20 years will be a reasonable age to check lipid profile in most communities. However in those with strong family history of lipid disorders or cardio vascular disease, earlier screening will be advisable. In fact 20 years was the original recommendation of the NCEP ATP guidelines.
thank you very much
In fact this question is both personal and definitely professional.On this forum i only intend to share professional stuff.
American academy of pediatrics has issued guidelines to screen ALL CHILDREN by 9-11 years initially and again between 17-21 years (Website reference attached)
https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/Physicians-Recommend-all-Children,-Ages-9-11,-Be-Screened-for-Cholesterol.aspx. Retrieved on 16-October-2108.
This is huge amount of testing for the world and sometimes create undue stress for the children. Contrary to that timely appreciation of excessive lipid accumulation tendencies can avoid future outcomes at an earlier age. It makes sense in this regard that if lipids are bad and excessive in some kids than why allowing them with that extra lipids to get accumulated over a decade and more. The screening can also be recommended as treatment is easy in the shape of life style modifications.
However, economic cost is attached to this.
So in the light of this i live between healthcare economy (ALL CHILDREN) to whether to do it for all kids or to pend it as you guys have suggested. I am not are if any other organization is recommended like this.
Your further input will be valuable
Regards
Hi Sikandar.. Very good question. Dr koshy and you have nicely discussed the issue. As Indian patient are prone to develop CAD much earlier than western counterpart, I think Indian people should be screened for lipid disorder much early and should be treated aggressively.. Thanks
It is also important to discuss not only the screening mechanisms for dyslipidaemias but also the interventions needed to manage patients with dyslipidaemias. I think the most important matter is to institute "life style modifications" as the essential intervention to manage the dyslipidaemia and associated co-morbidities (in many south asian patients, dyslipidaemia is part of the metabolic syndrome). Of course, pharmacological interventions should be considered in addition to lifestyle modifications as per the recognised clinical guidelines. Although statins have proved effective in modulating LDLc (inspite of some of the recent controversies regarding overtreatment in some patient cohorts), very few outcome studies have demonstrated the benefit of modulating HDLc or even triglycerides. The recent data from REDUCE IT with a synthetic omega 3 EPA is therefore very exciting. Please see our review " Development of Triglyceride-Lowering Drugs to Address Residual Cardiovascular Risk Strategic and Clinical Considerations July 2018 DOI 10.1093/ehjcvp/pvy029
The first things to do as being from the subcontinent and may be i t suits the whole world now to define following:
1- Time to first screen kids/adolescents in our population
2- Screening with total cholesterol or LDL-cholesterol to make it most cost-effective
3-Screening frequency may also be defined
4-If we delay we need more coronary care units whcih will be very expensive ask
5-Treatmnet like statins: those who need it being highly hypercolesterolemic, what possible issues can be there?
6-Health economy of screening all
Any way questions raised, please comment
Regards
Sikander,
You have raised some interesting points. However, the cost benefit of population wide screening of the younger population has been looked at and found to be low.
Therefore any screening program has to be targeted. Furthermore, the way forward is health education in schools and communities on the dangers of unhealthy lifestyle practices and encourage healthier living...a difficult message to convey with all the fast food advertising and other "modern" lifestyle activities!!!!
Sreeharan
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