Healthcare practitioners caring for adolescents transitioning into adulthood see disparities between pediatric and adult guidelines for lipid level treatment, according to a JAMA Pediatrics study published online in April.
Researchers compared the proportion of young adults 17 to 21 years old, who met criteria for pharmacologic treatment of LDL-C levels under pediatric versus adult guidelines, performing a cross-sectional analysis of the National Health and Nutrition Examination Survey. NHANES is a program that assesses health status in the U.S. using a national sample.
Health surveys were administered from 1999 through 2012, with analysis performed from June through December 2014 on 6,338 U.S. participants eligible for statin therapy, according to the study.
Of the group analyzed, 2.5% would qualify for statin treatment under the pediatric guidelines compared with 0.4% under adult guidelines. Participants who met pediatric criteria had lower mean levels — 167.3 vs. 210.0 — but higher proportions of other cardiovascular risk factors such as hypertension (10.8% vs. 8.4%); smoking (55% vs. 23.9%); and obesity (67.7% vs. 18.2%) compared with those who met adult guidelines, the study’s results showed.
If pediatric guidelines were applied to an extrapolated U.S. population of young adults with elevated lipid levels, 483,500 would be eligible for treatment compared to 78,200 who would qualify under adult guidelines, results showed. Applying pediatric guidelines for lipid levels, which consider additional cardiovascular risk factors beyond age and LDL-C concentration could result in statin treatment for more than 400,000 additional adolescents and young adults.
“The actual number treated is likely to be much lower owing to less than universal screening in this age group, challenges with adherence to medication regimens, and physician or patient disagreement with the recommendations,” researchers stated. “Given the current uncertain state of knowledge and conflicting guidelines for treatment of lipid levels among youth aged 17 to 21 years, physicians and patients should engage in shared decision making around the potential benefits, harms, and patient preferences for treatment.”
There is a lack of randomized clinical trials in young adults, according to the study. Those trials would require extensive follow-up to answer questions about the effect of statin therapy and risk for CVD events, the study stated.
“The 2013 American College of Cardiology and American Heart Association guidelines recommend shared decision making with patients for whom data are inadequate, including young people with a high lifetime risk for ASCVD,” researchers concluded. “Patients and clinicians should clearly address other modifiable risk factors, including optimizing diet, exercise, and weight and promoting abstinence from tobacco, as strongly recommended by both the pediatric and adult guidelines.”
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