Doctors Spar Over Cholesterol Screening in Kids
MONDAY July 23, 2012 -- Researchers are debating the merits of recent guidelines that recommend all children aged 9 through 11 be screened for high cholesterol levels, along with certain groups of younger children and teenagers.
The guidelines were written by a panel convened by the U.S. National Heart, Lung, and Blood Institute, endorsed by the American Academy of Pediatrics and published in the journal Pediatrics last November.
But now doctors publishing in the current issue of Pediatrics say the guidelines are too aggressive and not based solidly on evidence. The paper is joined by a rebuttal from the authors of the guidelines.
The critics of the guidelines make many arguments, including that the guidelines were based more on expert opinion than on solid evidence and that many authors of the guidelines reported industry disclosures.
Dr. Stephen Daniels, chairman of the guidelines panel and head of pediatrics at the University of Colorado School of Medicine in Aurora, defended the panel Monday to the Associated Press.
Industry ties "were vetted during the discussions of the panel and I think really did not influence the debate," he told the AP.
Daniels, a co-author of the rebuttal, reported having worked as a consultant or advisory board member for Abbott Laboratories, Merck and Schering-Plough, now part of Merck. Seven other panel members also made disclosures.
But the critics had other objections as well.
"There is expense and inconvenience to the family to have to get to the doctor before breakfast," said Dr. Thomas Newman, co-author of the journal commentary article, referring to the recommendation that higher-risk 2- to 8-year-olds and 12- to 16-year-olds be screened after fasting.
There also is the issue of potentially giving lifetime medication to a large group of people. The guidelines estimated that about 1 percent of kids would be put on cholesterol-lowering medications if the guidelines were followed.
"[We don't know] how many children would need to be treated to prevent one heart disease death," said Newman, who is a professor of epidemiology and biostatistics and pediatrics at the University of California, San Francisco. "The medications would have to be extraordinarily safe, and there haven't been big studies with large enough numbers of children for long enough to know."
Newman recommends cholesterol screening start at adulthood and obese children not be screened too early.
"Many of these kids have totally normal lipid levels and many with high lipid levels are not obese," he said. "You can tell if someone needs to lose weight without having to do any blood test and recommendations for diet and exercise really apply to everybody."
But the issue of whom to screen and when is far from straightforward, said one cardiologist who was involved with neither the original guidelines nor the rebuttal.
"It's a tough call; it's ... worthy of debate," said Dr. Stephen Cook, associate professor of pediatrics at the University of Rochester Medical Center in Rochester, N.Y. Cook also said there may be an argument for universal or near-universal screening to identify kids with familial hypercholesterolemia, a genetic trait resulting in high cholesterol levels unusually early in life.
Cholesterol-lowering drugs during childhood may be able to stave off heart disease in this group of children, the rebuttal authors noted.
The Nemours Foundation has more on children and cholesterol.
Posted: July 2012