New results from the
AAP Periodic Survey of
The authors found that pediatricians screen based
on selective criteria. For example, pediatricians reported screening 86% of 9- to 11-year-olds with
high-risk conditions, 82% with obesity and 69%
with family history of high cholesterol usually or
all the time. Screening rates were higher for 17- to
21-year-old patients (see figure).
For both the younger and older age groups, however, less than half of pediatricians reported screening
healthy patients as recommended by the 2011 National Heart, Lung, and Blood Institute (NHLBI)
expert panel guidelines (30% and 42%, respectively).
Nearly all pediatricians (97%) reported that they
would provide additional diet and exercise counseling
for a 9- to 11-year-old patient with persistently high
low-density lipoprotein cholesterol (LDL-C, 200
mg/dL, 5. 2 mmol/L) despite six months of lifestyle
counseling. Over three-quarters (76%) would refer
the patient to a dietitian, 54% would refer the patient
to a lipid specialist and 8% would prescribe a statin.
The most commonly reported major barriers to
lipid treatment included the inability of patients
and families to adhere to lifestyle recommendations
(83%), pediatrician lack of comfort prescribing
statins (62%), lack of patient access to appropriate
physical activity (49%) and lack of patient access to
affordable healthy food (47%).
Study authors suggested that better education is
needed regarding recommended screening and treatment approaches, the health consequences of severe
lipid disorders, and the benefits and potential harms
Of pediatricians providing health supervision,
46% report being moderately or very knowledgeable
about the 2008 AAP guidelines. Fewer pediatricians
(26%) reported familiarity with the 2011 NHLBI
expert panel guidelines, which include recommendations for universal screening of healthy children,
and 26% reported familiarity with the 2007 U.S.
Preventive Services Task Force evidence review on
pediatric lipid screening and treatment.
Periodic Survey #87 was conducted from December 2013 to June 2014. The survey was mailed to
1,627 nonretired AAP members in the United States,
with a response rate of 43%. Analyses were limited to
pediatricians who provide direct patient care.
Survey: Many pediatricians don’t follow lipid recommendations
Percentage of pediatricians screening for lipid disorders, 2014
Patient with high-risk condition
Patient with obesity
Patient with family history of high cholesterol
Patient with family history of heart attack or stroke
0 10 20 30 40 50 60 70 80 90 100
of pediatricians providing
AAP Periodic Survey #87
Source: de Ferranti SD, et al., J Pediatr. 2017;185:99-105, http://www.jpeds.com/article/S0022-3476( 17)30003-3/pdf
9-11 years old 17-21 years old
• In 2011, the NHLBI released Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk
Reduction in Children and Adolescents. The Academy
endorsed the report, and a summary was published
in Pediatrics, http://pediatrics.aappublications.org/con
• For more information on pediatric cardiovascular
risk-reduction strategies, contact Debra Burrowes, in
the AAP Division of Technical and Medical Services, at
847-434-4927 or email@example.com.
• For more information on the Periodic Survey of Fellows,
or contact Blake Sisk, in the AAP Division of Health Services Research, at 847-434-7630 or firstname.lastname@example.org.