Pediatricians Recommend Cholesterol Drugs for Some Kids
MONDAY, July 7 -- In a further concession to the impact of the childhood obesity epidemic in the United States, a leading group of pediatricians is recommending that kids as young as 8 years old be given cholesterol-lowering drugs in hopes of preventing heart problems later in life.
The American Academy of Pediatrics also recommends that children as young as 2 years old start having their cholesterol levels screened if they have a family history of heart disease or high cholesterol. Screening should start no later than 10, the academy said.
Dr. Steven P. Shelov, chairman of pediatrics at Maimonides Medical Center and head of Maimonides Infants & Children's Hospital in New York City, said he agreed with the new guidelines. "More aggressive screening is a good idea, and the use of [cholesterol-lowering] statins at relatively low doses will keep cholesterol at safer ranges."
The academy is also recommending that children whose family history of cholesterol is not known, or who have risk factors for heart disease -- including obesity, high blood pressure or diabetes -- have their cholesterol tested.
The recommendations were published in the July issue of the journal Pediatrics.
According to the recommendation, the best method for checking cholesterol is a fasting blood test. Children whose cholesterol is normal should have the test repeated every three to five years.
For those children older than 8 who have high levels of LDL (bad) cholesterol, doctors should consider giving them statins.
For younger children with high cholesterol, lifestyle changes such as losing weight and increasing physical activity, as well as nutritional counseling, should be considered.
Also, for children 1 year old and older who may be overweight or obese, the academy recommends giving them low-fat dairy products such as 2 percent milk and other low-fat dairy foods.
Before issuing the new guidelines, the academy said cholesterol-lowering medications should be considered for children older than 10, if they were unable to lose weight after one year of trying.
Some 30 percent to 60 percent of U.S. kids with high cholesterol are falling through the cracks, being neither diagnosed nor treated.
Shelov, who was not involved in drafting the recommendations, said he isn't overly concerned about giving statins to children. Side effects are rare, and the benefits of the drugs make them worth the risk, he said.
"The levels of obesity we are seeing and the unsafe level of cholesterol now in our teenagers -- even down as young as our fourth- and fifth-graders -- this recommendation appears to be well thought out," he said.
Shelov admitted that very little is known about the risks and benefits of using cholesterol-lowering drugs like statins in a large pediatric population.
Potentially, millions of children could be placed on cholesterol-lowering drugs, he said. "At the same time, there needs to be a systematic look at the effects of these medications on children, because they do have side effects," he added.
"If we are going to go ahead and do this, we're going to need guidelines on exactly who would warrant the therapy and careful measurement of any side effects," Shelov said.
It's possible that many children who start taking statins would not be on them for life. Changes in diet and exercise could have some children off the drugs in a relatively short time, Shelov said.
For more on the dangers of cholesterol, visit the American Heart Association.
Posted: July 2008
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