Kohler Rachel, Lilly Christa, Poffenberger Page, Burton Will, Damarputra Naby, Cottrell Lesley, Elliott Eloise, Pyles Lee A
Lake Erie College of Osteopathic Medicine, Erie, PA.
Department of Epidemiology and Biostatistics, West Virginia University School of Public Health, Morgantown, WV.
J Pediatr Clin Pract. 2024 Mar 16;11:200109. doi: 10.1016/j.jpedcp.2024.200109. eCollection 2024 Mar.
The Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) project surveyed cardiometabolic risk factors to identify risk for adult heart disease through a school-based program. This current investigation determined the follow-up status of children who were identified with elevated low-density lipoprotein cholesterol (LDL-C) level that suggests a diagnosis of familial hypercholesterolemia (FH). We hypothesized deficient follow-up of persons identified with probable FH from screening LDL-C in West Virginia (WV) fifth-grade classes. Other markers suggested ongoing health care for many of these persons.
Between 1998 and 2016, 60 404 children in the fifth grade had LDL-C levels identified through the CARDIAC Project. Of the 632 children who had probable FH, 398 were subsequently identified through the electronic health record, phone calls, and mail surveys. The institutional review board at West Virginia University approved verbal consent for follow-up. Information obtained included any medical care, medications including cholesterol-lowering (CLM), and family history of cardiac events.
Of the 398 children previously screened in WV CARDIAC Project, 75 (19%) had follow-up lipid panels. Fifty-six subjects not on a CLM had an LDL-C that was 27.96 ± 93.4 mg/dL lower than the fifth-grade baseline ( < .001), whereas no significant change was seen in those on a CLM. Overall, 46% of participants indicated no health care interaction after screening, and 34% of participants showed interaction without a follow-up lipid panel.
A suboptimal midterm effect of FH identification was noted in fifth graders. Universal screening as was offered in WV must be linked to a follow-up system that engages primary providers, parents, and children to embrace life-saving preventive practices.
阿巴拉契亚社区冠状动脉风险检测（CARDIAC）项目通过一项基于学校的计划，对心脏代谢风险因素进行了调查，以确定成人心脏病风险。本次调查确定了那些被查出低密度脂蛋白胆固醇（LDL-C）水平升高、提示患有家族性高胆固醇血症（FH）的儿童的随访情况。我们假设，在西弗吉尼亚州（WV）五年级班级中，通过筛查LDL-C确诊为可能患有FH的人群的随访情况不佳。其他指标表明，这些人中许多人仍在接受医疗保健。
1998年至2016年期间，CARDIAC项目对60404名五年级儿童的LDL-C水平进行了检测。在632名可能患有FH的儿童中，有398名随后通过电子健康记录、电话和邮件调查得以确认。西弗吉尼亚大学的机构审查委员会批准了随访的口头同意书。获得的信息包括任何医疗护理、药物治疗（包括降胆固醇药物）以及心脏事件家族史。
在WV CARDIAC项目之前筛查的398名儿童中，75名（19%）进行了随访血脂检测。56名未服用降胆固醇药物的受试者的LDL-C水平比五年级基线水平低27.96±93.4mg/dL（P<0.001），而服用降胆固醇药物的受试者则未出现显著变化。总体而言，46%的参与者表示筛查后没有医疗保健互动，34%的参与者表示有互动但未进行随访血脂检测。
五年级学生中FH识别的中期效果欠佳。WV所提供的普遍筛查必须与一个后续系统相联系，该系统促使初级医疗服务提供者、家长和儿童接受挽救生命的预防措施。
