The review included 160 studies on screening and testing for dyslipidaemia, 68 studies of interventions or of lipid level monitoring over time, eight studies of the adverse effects of screening and 81 studies of the adverse effects of treatment.
No studies evaluated the effect of screening for dyslipidaemia in childhood and adolescence on adult lipid levels and CHD.
Normal ranges for lipids in children and adolescents were currently defined by population levels; recent studies had shown age, gender and racial variations. Current screening recommendations based on family history had limited accuracy (missing 30 per cent to 60 per cent of children with elevated lipids), low adherence by service providers and limited acceptance by parents and children. Single measures of total cholesterol (TC) are inadequate to classify children correctly.
Studies of statin treatment in children with monogenic dyslipidaemias (FH or familial combined hyperlipidaemia (FCH)) showed effectiveness in reducing TC (mean reduction 24.4 per cent (95% CI: 19.5, 29.2, n = 9 studies), and low density lipoprotein (LDL) (mean reduction 30.8 per cent, 95% CI: 24.1, 37.5, n = 8 studies). Two trials showed benefit from bile acid binding resins in this population. RCTs of dietary supplements and advice showed marginal improvements.
Six trials of exercise interventions in children without monogenic dyslipidaemias showed no effect on lipid levels percentage mean reduction in TC 0% (95% CI: -5.6, 5.6) and percentage mean reduction in LDL 3.1% (95% CI: -7.7, 1,5). One study showed that high intensity counselling was effective, but effectiveness ceased when the intervention was stopped. Studies of dietary advice and supplements showed no effect.
A variety of adverse effects of therapy were reported (full details in the report), but none were serious. Studies were generally small and of insufficient duration to determine long-term effects.