Lipid profile screening and ASCVD prevention

ABSTRACT

Introduction

Atherosclerotic cardiovascular disease (ASCVD) is the main cause of morbidity and mortality worldwide. Dyslipidemia, in particular elevation of LDL-cholesterol levels (LDL-C), is one of the major cardiovascular risk factors and is characterized by high prevalence and independent unfavorable impact on cardiovascular prognosis; however, because of its asymptomatic course, it often remains undiagnosed. Strategies aimed at early identification of subjects with elevated LDL-C levels may allow early intervention, preventing ASCVD development.

Areas covered

The purpose of this review is to summarize the recommendations of current guidelines by leading scientific authorities on the pros and cons of lipid profile screening programs.

Expert opinion

Systematic assessment of LDL-C levels as part of global cardiovascular risk assessment in all adults is a cornerstone of ASCVD risk prevention. In young adults, adolescents, and children, selective lipid profile screening may be useful to reduce the impact of high cholesterol levels on ASCVD risk in the presence of specific conditions including either family history of early ASCVD or multiple concomitant cardiovascular risk factors. Cascade screening for family members of individuals diagnosed with familial hypercholesterolemia (FH) may be also of great clinical impact. Further evidence is needed to evaluate the cost/benefit ratio of systematic assessment of lipid profile in children, adolescents, and young adults.

KEYWORDS:

• ASCVD risk
• dyslipidemia
• LDL-cholesterol
• lipids
• prevention
• screening

Article highlights

• Determination of lipid profile in apparently healthy adults is a cornerstone of ASCVD risk prevention, as part of comprehensive cardiovascular risk assessment, aimed to tail the necessary preventive intervention.

• In young adults, adolescents, and children, lipid screening can identify subjects who could benefit from primary CV preventive intervention and for an early detection of conditions associated with high risk of premature ASCVD, such as familial hypercholesterolemia.

• Among screening programs, cascade screening, involving family members of an individual with newly diagnosed familial hypercholesterolemia, is currently strongly recommended.

• Selective screening, based on clinical history have demonstrated a weak ability to early detect young individuals with elevated cholesterol levels.•

• The potential role of a systematic lipid screening in pediatric age remains debated.

• The low cost of the test and the absence of significant adverse effects may support the viability of systematic screening in children and young adults for early detection of severe dyslipidemias.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.