In the current issue of JAMA, the US Preventive Services Task Force (USPSTF) has published the results of its most recent evidence reviews and recommendations on screening for lipid disorders in children and adolescents.^1-3 The recommendation statement is an I statement, meaning that the USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for lipid disorders in children and adolescents 20 years or younger. This is an update of the last statement, which had a similar recommendation and grade.⁴

There are some important advances in the most recent analysis, but there are also some lingering concerns. The major change is the focus on screening for familial hypercholesterolemia (FH) in addition to multifactorial dyslipidemia. In the previous analysis, those with genetic forms of dyslipidemia were included only in a general approach to dyslipidemia, and those with known monogenic dyslipidemia were excluded.⁴ As heterozygous FH is one of the most common genetic abnormalities (occurring in approximately 1 in 250 individuals) and is associated with substantial elevation of the low-density lipoprotein cholesterol level, which in turn is associated with premature coronary artery disease and is amenable to treatment, why is an I statement given? It is important to note that in any systematic review of the evidence, the answer you get depends on the question you ask. This is particularly true for the kind of evidence review performed by the USPSTF to develop recommendations. Each review is based on a series of key questions. These key questions drive the evidence review and, ultimately, the conclusion, recommendation, and grade. The key questions for the recommendation on lipid screening in children and adolescents are listed in Table 1.