A study on the compliance with the NHLBI guideline for lipid screening of the paediatric population of Hong Kong

Abstract

Introduction: A strong link has been established between childhood dyslipidemia and adult manifestation of Cardiovascular diseases (CVD). Early recognition and control of risk factors that promote CVD could be pre-eminent to preventing disease. In view of this, The National Heart, Lung, and Blood Institute (NHLBI) released the current paediatric guidelines for cardiovascular health and risk reduction in 2011. This study investigated the clinical compliance to this guideline in the paediatric population of Hong Kong to determine its practicality and uptake in practice.

Methods: A retrospective observational study was conducted on the dyslipidaemic paediatric population positive for Human Immunodeficiency Virus (HIV), obesity, Kawasaki Disease (KD) and Diabetes Mellitus (DM) – Type 1 and type 2. All subjects who were receiving treatment and/or were seen at Queen Mary Hospital (QMH) for these conditions during the time frame of this study have been included. 292 out of 307 medical records of subjects diagnosed with KD were reviewed separately for a deeper analysis. In total, information from 1306 records was extracted to identify adherence to the current lipid screening guideline.

Results: Childhood dyslipidaemia was prevalent amongst all four risk factor groups. The highest prevalence was amongst the subjects diagnosed with HIV, followed by subjects diagnosed with DM – type 1 and/or 2 with the prevalence rate at 93.3% and 68% respectively. 88.2% of the subjects diagnosed with HIV, 88.8% diagnosed with obesity, 12.3% diagnosed with KD and 89.8% diagnosed with DM – type 1 and/or type 2 had conducted a lipid profile atleast once. Younger age of symptoms manifestation and coronary artery involvement in children with KD was presumed to be a contributory factor to the low prevalence of screening in that population. The highest prevalence of screening amongst the 9-11 year olds was in the HIV group of subjects with a prevalence rate of 40%, showing an incomplete adherence to the NHLBI guideline.

Conclusions: Identifying and treating childhood dyslipidaemia could be critical in reducing the global burden of CVD. The latest NHLBI guideline on cardiovascular health and risk reduction was formulated to reduce this burden. This study appears to be the first local study to present data on the lipid screening compliance to the NHLBI guideline in Hong Kong. This data aimed to draw attention to the existence of this guideline and bring forth a discussion on the use of this guideline in clinical practice. Results suggested that conforming to this guideline was uncommon in Hong Kong. Findings could facilitate a healthy discussion among specialists about the necessity to increase the rates of lipid screening in children with high/moderate risk factors for CVD according to the NHLBI guideline or maintain current treatment practices due to the claimed impractical nature of the guideline.