Pediatric dyslipidemia in British Columbia : population-level analysis, clinical practice gaps, and the impact of a knowledge translation intervention

Background: Pediatric dyslipidemias, including Familial Hypercholesterolemia (FH), remain underdiagnosed and undertreated in British Columbia (BC), despite an estimated prevalence of 1 in 250 to 1 in 90 individuals. Estimates from previous national surveys indicated that less than 10% of eligible children are being screened. In 2022, the Canadian Cardiovascular Society (CCS) and Canadian Pediatric Cardiology Association (CPCA) released updated guidelines recommending universal lipid screening between ages 2–10, diagnostic thresholds for pediatric dyslipidemias, and the use of statins as safe and effective treatment alongside lifestyle changes. However, provincial data on prevalence and management remain limited, and uptake of these guidelines among BC primary care providers has been minimal. This thesis addressed these gaps by: (1) quantifying rates of lipid testing, diagnosis, and pharmacologic treatment of pediatric dyslipidemias in BC from 2000–2021 using population-level administrative data; (2) surveying BC family physicians and pediatricians on their clinical practices, confidence, and perceived barriers to identifying and managing FH and related disorders; and (3) designing, implementing, and evaluating an accredited continuing medical education (CME) intervention to enhance guideline uptake. Methods: Administrative health data for over 2.4 million children in BC were analyzed using Population Data BC. A 12-item survey was distributed via professional associations, site visits, and academic networks. An accredited CME course was developed and delivered, with pre- and post-intervention surveys assessing changes in provider confidence, knowledge, and self-reported practice. Results: Of 2.4 million children in BC, only 4.5% received cholesterol testing. Based on estimated prevalence, approximately 9,600 cases of FH would be expected; however, only 543 were diagnosed, representing just 5.6% of expected cases. Among those diagnosed, only 51 (9.4%) were prescribed statins. Survey results revealed low screening rates, low provider confidence, and limited guideline awareness. Post-CME, significant improvements were observed in confidence (p<0.001), screening practices (p<0.001), and adherence to recommended care, including statin initiation (+23%), specialist referral (+36%), and dietary counselling (+29%) (all p<0.05). Conclusion: Pediatric dyslipidemias remain substantially underdiagnosed in BC. However, targeted knowledge translation can significantly improve provider confidence and alignment with national guidelines.