Limitations of current screening methods for lipid disorders in Korean adolescents and a proposal for an effective detection method: a nationwide, cross-sectional study

Abstract

Purpose: To determine the limitations of current screening methods for lipid disorders and to suggest a new method that is effective for use in Korean adolescents.

Methods: Data from the 6th Korea National Health and Nutrition Examination Survey (2013-2015) were analyzed. The diagnostic validity (sensitivity and specificity) of various cardiovascular risk factors currently used for lipid disorder screening was investigated, as was the diagnostic validity of non-HDL-cholesterol ≥145 mg/dL as a screening tool.

Results: The prevalence of dyslipidemia and familial hypercholesterolemia (FH) among Korean adolescents was 20.4%±1.0% and 0.8%±0.3%, respectively. The current standard screening methods identified only 5.9%±1.4% and 30.3%±17.2% of the total number of dyslipidemia and FH cases, respectively. The diagnostic sensitivity and specificity of lipid profile analysis for dyslipidemia among obese adolescents were 19.5%±2.3% and 93.6%±0.8% and for FH were 30.3%±17.2% and 91.1%±0.8%, respectively. When adolescents with obesity, hypertension, or a family history of dyslipidemia or cardiocerebrovascular disease for over 3 generations were included in the screening, diagnostic sensitivity increased to 68.4%±2.8% for dyslipidemia and 83.5%±2.7% for FH. Universal screening of all adolescents based on non-HDL-cholesterol levels had sensitivities of 30.2%±2.7% and 100%, and specificities of 99.2%±0.3% and 94%±0.6% for dyslipidemia and FH, respectively.

Conclusion: New screening methods should be considered for early diagnosis and treatment of lipid disorders in Korean adolescents.

Keywords: Adolescent; Dyslipidemia; Hypercholesterolemias; Familial; Screening.

Fig. 1.

Prevalence of lipid disorders in Korean adolescents 10–18 years old. Data are from the Korea National Health and Nutrition Examination Survey VI, 2013–2015. HDL-C, high-density lipoprotein-cholesterol; TG, triglycerides; TC, total cholesterol; LDL-C, low-density lipoprotein-cholesterol. Dyslipidemia was defined as a case with at least one of the following conditions: TC≥200 mg/dL, TG≥150 mg/dL, HDL-C<40 mg/dL, and LDL-C≥130 mg/dL. Numbers in parentheses indicate unweighted counts.

Fig. 2.

Identification of dyslipidemia based on the current Korean selective screening test for lipid disorders. Boxes with dashed lines indicate likelihood to be selected at each step depending on the current screening test method for lipid disorders. Boxes with dotted lines indicate counts excluded from a screening test. Numbers in parentheses indicate unweighted counts. TC, total cholesterol.

Fig. 3.

Identification of familial hypercholesterolemia (FH) based on the current Korean selective screening test for lipid disorders. Boxes with dashed lines indicate likelihood to be selected at each step depending on the current screening test method for familial hypercholesterolemia. Boxes with dotted lines indicate counts excluded from a screening test. Numbers in parentheses indicate unweighted counts. TC, total cholesterol.

Fig. 4.

(A) Box plot of non-HDL-C values comparing cases with and without dyslipidemia. Median values and interquartile ranges are represented by horizontal black lines in the upper and lower bounds of the box, respectively. (B) Box plot of non-HDL-C values comparing cases with and without suspected familial hypercholesterolemia. Median values and interquartile ranges are represented by horizontal black lines in the upper and lower bounds of the box, respectively. HDL-C, high-density lipoprotein-cholesterol.