Lipid screening in young adults still unsettled

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 US Preventive Services Task Force recommendations on lipid screening.

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 likehood 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 Systenatic Review, Medicine, reference lists, and Clinical Trials, said the lead author of the update and director of the Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, Portland.

They were unable to find any randomized trials, cohort studies, or case-control studies comparing lipid screening against no lipids 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. However the potential adverse effects of statin therapy initiated in young adulthood and continued for decades haven’t been well studied.

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 effected patients have such a low rate of coronary heart disease events before age 40 (approximately 10 percent), that the potential benefits of screening for this reason are very limited.