A Survey of Cholesterol Disease Management in Pediatric Cardiology

Background: Genetic cholesterol diseases are common yet frequently unrecognized in children. Although adult heart disease is the most common cause of death in the US and has its origins in childhood, pediatric cardiologists may not consistently address this issue in their clinical practice. Primary care providers may presume that pediatric cardiologists have expertise in cholesterol disease management, but little information exists regarding their training and management practices.

Methods: We created an online survey to addresses how pediatric cardiologists approach cholesterol screenings and cholesterol disease management. Respondents were asked about their formal training in the diagnosis and management of cholesterol diseases. They were also asked about their comfort using statins (cholesterol reducing drugs). We asked for their treatment recommendations for five hypothetical patients which were then compared to standard recommendations from the American Heart Association (AHA) guidelines.

Results: One hundred individuals completed the survey. 49 reported that they had very little or no formal training in cholesterol disease management, and 15 reported having moderate to extensive training.

35 respondents were somewhat or extremely uncomfortable prescribing a statin. 53 underestimated the incidence of Familial Hypercholesterolemia by between 2 and 20-fold.

For two of the vignettes presented, AHA guidelines would not recommend a statin. Most respondents appropriately chose not to treat with a statin in the case of obesity (75%) and family history of early heart disease (56%).
For the other three vignettes, AHA guidelines would recommend treatment with a statin. Most respondents appropriately chose to treat with a statin in the case of a giant coronary aneurysm (88%), familial hypercholesterolemia (83%) and insulin dependent diabetes (81%).

Conclusion: Many pediatric cardiologists report gaps in their training and limits in their comfort with pediatric cholesterol disease management. Despite this, respondents gave recommendations generally consistent with AHA treatment guidelines.