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Editorial Screening for lipid disorders in children and adolescents can identify 2 types of lipid disorders: primary lipid disorders, which typically are monogenic, rare, and severe, and the more common secondary lipid disorders that often result from other disease processes or lifestyle behaviors (such as poor nutrition or inadequate activity) and are often less severe. Universal lipid testing in childhood will identify at least 1 abnormal lipid value in 1 of every 5 children aged 12 to 19 years.[2] Unlike the severe elevations in LDL-C level observed in children with FH, these are predominantly mild abnormalities in levels of triglycerides and high-density lipoprotein cholesterol from secondary lipid disorders, often due to lifestyle behaviors. [Extracted from the article]

In most cases, the results of a large clinical trial will agree with the meta-analysis of the smaller trials on that same topic. This was demonstrated by researchers who identified 79 meta-analyses that included one large study of 1,000 or more patients and 61 meta-analyses that included one large study based on statistical power. In 82% to 90% of the cases, the large trial confirmed the results of the meta-analysis. In the 15 cases where the large trial did not confirm the meta-analysis, most of the difference could be accounted for., Objective.--To evaluate the results of large clinical trials vs the pooled results of smaller trials. Data Identification.--Meta-analyses with at least I "large" study were identified from the Cochrane Pregnancy and Childbirth Database and from MEDLINE (1966-1995). Study Selection.--We used a sample size approach to select 79 meta-analyses with at least 1 large study of 1000 or more patients. We used a statistical power approach to select 61 meta-analyses with at least 1 large study based on statistical power considerations. Data Extraction.--The outcome of interest for each meta-analysis was the primary one stated in the original publication or, when not clearly specified, was decided on clinically. Data Synthesis.--By random effects calculations, we found agreement between large and smaller trials in 90% of the meta-analyses selected by the sample size approach and in 82% of the meta-analyses selected by the statistical power approach. Twice as many disagreements appeared when the variability among large studies and among smaller studies was not considered (ie, fixed effects calculations). Of the 15 disagreements between results of large and smaller trials using the random effects model, plausible explanations were identified in 10 meta-analyses: 5 with differences in the control rate of events between large and smaller trials, 4 with specific protocol or study differences, and 1 with potential publication bias. Two other disagreements were not clinically important, and tentative reasons could be identified for 2 of the remaining 3 disagreements. Conclusions.--Results of smaller studies are usually compatible with the results of large studies, but discrepancies do occur even when the diversity among both large studies and smaller studies is considered. Clinically important differences without a potential explanation are extremely uncommon. Future research should further examine sources of heterogeneity between the results of large and smaller trials. JAMA. 1996;276:1332-1338

Importance: Favorable trends occurred in the lipid levels of US youths through 2010, but these trends may be altered by ongoing changes in the food supply, obesity prevalence, and other factors.Objective: To analyze trends in levels of lipids and apolipoprotein B in US youths during 18 years from 1999 through 2016.Design, Setting, and Participants: Serial cross-sectional analysis of US population-weighted data for youths aged 6 to 19 years from the National Health and Nutrition Examination Surveys for 1999 through 2016. Linear temporal trends were analyzed using multivariable regression models with regression coefficients (β) reported as change per 1 year.Exposures: Survey year; examined periods spanned 10 to 18 years based on data availability.Main Outcomes and Measures: Age- and race/ethnicity-adjusted mean levels of high-density lipoprotein (HDL), non-HDL, and total cholesterol. Among fasting adolescents (aged 12-19 years), mean levels of low-density lipoprotein cholesterol, geometric mean levels of triglycerides, and mean levels of apolipoprotein B. Prevalence of ideal and adverse (vs borderline) levels of lipids and apolipoprotein B per pediatric lipid guidelines.Results: In total, 26 047 youths were included (weighted mean age, 12.4 years; female, 51%). Among all youths, the adjusted mean total cholesterol level declined from 164 mg/dL (95% CI, 161 to 167 mg/dL) in 1999-2000 to 155 mg/dL (95% CI, 154 to 157 mg/dL) in 2015-2016 (β for linear trend, -0.6 mg/dL [95% CI, -0.7 to -0.4 mg/dL] per year). Adjusted mean HDL cholesterol level increased from 52.5 mg/dL (95% CI, 51.7 to 53.3 mg/dL) in 2007-2008 to 55.0 mg/dL (95% CI, 53.8 to 56.3 mg/dL) in 2015-2016 (β, 0.2 mg/dL [95% CI, 0.1 to 0.4 mg/dL] per year) and non-HDL cholesterol decreased from 108 mg/dL (95% CI, 106 to 110 mg/dL) to 100 mg/dL (95% CI, 99 to 102 mg/dL) during the same years (β, -0.9 mg/dL [95% CI, -1.2 to -0.6 mg/dL] per year). Among fasting adolescents, geometric mean levels of triglycerides declined from 78 mg/dL (95% CI, 74 to 82 mg/dL) in 1999-2000 to 63 mg/dL (95% CI, 58 to 68 mg/dL) in 2013-2014 (log-transformed β, -0.015 [95% CI, -0.020 to -0.010] per year), mean levels of low-density lipoprotein cholesterol declined from 92 mg/dL (95% CI, 89 to 95 mg/dL) to 86 mg/dL (95% CI, 83 to 90 mg/dL) during the same years (β, -0.4 mg/dL [95% CI, -0.7 to -0.2 mg/dL] per year), and mean levels of apolipoprotein B declined from 70 mg/dL (95% CI, 68 to 72 mg/dL) in 2005-2006 to 67 mg/dL (95% CI, 65 to 70 mg/dL) in 2013-2014 (β, -0.4 mg/dL [95% CI, -0.7 to -0.04 mg/dL] per year). Favorable trends were generally also observed in the prevalence of ideal and adverse levels. By the end of the study period, 51.4% (95% CI, 48.5% to 54.2%) of all youths had ideal levels for HDL, non-HDL, and total cholesterol; among adolescents, 46.8% (95% CI, 40.9% to 52.6%) had ideal levels for all lipids and apolipoprotein B, whereas 15.2% (95% CI, 13.1% to 17.3%) of children aged 6 to 11 years and 25.2% (95% CI, 22.2% to 28.2%) of adolescents aged 12 to 19 years had at least 1 adverse level.Conclusions and Relevance: Between 1999 and 2016, favorable trends were observed in levels of lipids and apolipoprotein B in US youths aged 6 to 19 years. [ABSTRACT FROM AUTHOR]

The article discusses a cross-sectional analysis of cholesterol testing between 1995 and 2010 among patients aged 2 to 21 years during health maintenance visits in the U.S. The use of the National Ambulatory Medical Care Survey (NAMCS) to study the trends in testing is mentioned. It reveals that the study found no increase in the odds of testing after the American Academy of Pediatrics (AAP) and the U.S. Preventive Services Task Force (USPSTF) released their statements.

The authors reflect on the U.S. Preventive Services Task Force's recommendations on lipid screening in children and adolescents, and it mentions the claim that clinicians, who already test all newborns for phenylketonuria, should perform screening to detect familial hypercholesterolemia (FH) and pediatric lipid disorders in newborns. Screening for multifactorial dyslipidemia is examined, along with other lipid disorders such as combined dyslipidemia of obesity.

The article discusses a research related to demographics of congenital heart disease hospitalizations for childeren and adults in the U.S. from 1998 through 2010. It mentions that continuous variables were compared using t-tests and categorical variables were compared using chi-squared tests. The results indicated that annual number of congenital heart disease hospitalizations among adults increased more quickly and consistently from 1998 through 2010 than pediatric hospitalizations.

In this article the author comments on the study "Trends in serum lipids among US youths aged 6 to 19 years, 1988-2010" by Kit B. K. and colleagues, published in the current issue of the journal. The study reports that that total cholesterol (TC) declined in children aged 6 to 19 years over the past 2 decades. It also showed that low-density lipoprotein (LDL) and triglyceride levels both declined in adolescents aged 12-19 years with available fasting serum specimen.

Importance: Familial hypercholesterolemia (FH) is a genetic disorder that often results in severely high low-density lipoprotein cholesterol (LDL-C) and high risk of premature coronary heart disease (CHD). However, the impact of FH variants on CHD risk among individuals with moderately elevated LDL-C is not well quantified., Objective: To assess CHD risk associated with FH variants among individuals with moderately (130-189 mg/dL) and severely (≥190 mg/dL) elevated LDL-C and to quantify excess CHD deaths attributable to FH variants in US adults., Design, Setting, and Participants: A total of 21 426 individuals without preexisting CHD from 6 US cohort studies (Atherosclerosis Risk in Communities study, Coronary Artery Risk Development in Young Adults study, Cardiovascular Health Study, Framingham Heart Study Offspring cohort, Jackson Heart Study, and Multi-Ethnic Study of Atherosclerosis) were included, 63 of whom had an FH variant. Data were collected from 1971 to 2018, and the median (IQR) follow-up was 18 (13-28) years. Data were analyzed from March to May 2023., Exposures: LDL-C, cumulative past LDL-C, FH variant status., Main Outcomes and Measures: Cox proportional hazards models estimated associations between FH variants and incident CHD. The Cardiovascular Disease Policy Model projected excess CHD deaths associated with FH variants in US adults., Results: Of the 21 426 individuals without preexisting CHD (mean [SD] age 52.1 [15.5] years; 12 041 [56.2%] female), an FH variant was found in 22 individuals with moderately elevated LDL-C (0.3%) and in 33 individuals with severely elevated LDL-C (2.5%). The adjusted hazard ratios for incident CHD comparing those with and without FH variants were 2.9 (95% CI, 1.4-6.0) and 2.6 (95% CI, 1.4-4.9) among individuals with moderately and severely elevated LDL-C, respectively. The association between FH variants and CHD was slightly attenuated when further adjusting for baseline LDL-C level, whereas the association was no longer statistically significant after adjusting for cumulative past LDL-C exposure. Among US adults 20 years and older with no history of CHD and LDL-C 130 mg/dL or higher, more than 417 000 carry an FH variant and were projected to experience more than 12 000 excess CHD deaths in those with moderately elevated LDL-C and 15 000 in those with severely elevated LDL-C compared with individuals without an FH variant., Conclusions and Relevance: In this pooled cohort study, the presence of FH variants was associated with a 2-fold higher CHD risk, even when LDL-C was only moderately elevated. The increased CHD risk appeared to be largely explained by the higher cumulative LDL-C exposure in individuals with an FH variant compared to those without. Further research is needed to assess the value of adding genetic testing to traditional phenotypic FH screening.