Screening
Your Organisational Guidance
ebpracticenet urges you to prioritise the following organisational guidance:
Évaluation du risque cardiovasculaire en première lignePublished by: Domus MedicaLast published: 2010Cardiovasculaire risicobepaling in de eerste lijnPublished by: Domus MedicaLast published: 2020Évaluation du risque cardiovasculaire en première lignePublished by: Domus MedicaLast published: 2020There is a well-established link between hypercholesterolaemia and coronary heart disease, and a high incidence and prevalence of hypercholesterolaemia in high-income countries. Lowering of low-density lipoprotein cholesterol (LDL-C) leads to a reduction of cardiovascular events in moderate- to high-risk patients.
The American College of Cardiology/American Heart Association (ACC/AHA) recommends that in adults without atherosclerotic cardiovascular disease (ASCVD), traditional ASCVD risk factors, including lipid levels, are assessed every 4-6 years.[44] The Centers for Disease Control and Prevention (CDC) recommends more regular screening than this in adults with cardiovascular risk factors (e.g., existing cardiovascular disease [CVD], diabetes, positive family history of lipid disorders).[50] The use of a validated tool or calculator to predict future risk of ASCVD is recommended.[51]
In the UK and Europe, lipid screening may begin at age 40 years, although UK guidance recommends a systematic but opportunistic risk-assessment approach targeting adults at increased risk who are above this age, rather than universal screening.[41][52] The European Society of Cardiology (ESC) and European Atherosclerosis Society recommend CVD risk factor screening, including lipid profile testing, be considered in men >40 years old and in women >50 years old and/or who are menopausal, which may be followed by use of a formal risk assessment tool (such as Systemic Coronary Risk Evaluation [SCORE], or a newer version such as SCORE-2) to decide on prevention strategies in adults over the stated risk thresholds.[41][53] Note that although the ESC recommends the SCORE/SCORE-2 risk assessment tool, ideally risk calculators should be population-specific, and clinicians should follow the risk-assessment tools endorsed in their own region or national guidelines.[41]
Screening may begin earlier for those with diabetes in childhood or a family history of dyslipidaemia. The 2018 ACC/AHA guidelines additionally recommend screening as early as age 2 years for those with a family history suggestive of early ASCVD.[44] The US Preventive Services Task Force found that the current evidence is insufficient to assess the balance of benefits and harms of screening for lipid disorders in asymptomatic children and adolescents aged 20 years or younger.[54]
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