July 8, 2008

Group Urges Cholesterol Medication for Children

By Tara Parker Pope

U.S. pediatricians are recommending wider cholesterol screening for children and more aggressive use of cholesterol-lowering drugs starting as early as the age of 8 in hopes of preventing adult heart problems.

The new guidelines, issued Monday by the American Academy of Pediatrics, also call for giving children low-fat milk after 12 months of age.

The push to aggressively screen and medicate for high cholesterol in children is certain to incite controversy amid a continuing debate about the use of prescription drugs in children as well as the best approaches to ward off heart disease in adults.

But proponents say there is growing evidence that the first signs of heart disease show up in childhood, and with 30 percent of children in the United States overweight or obese, many doctors fear a rash of early heart attacks and diabetes is on the horizon as these children grow up.

The academy estimates that under the current guidelines for cholesterol screening, between 30 percent and 60 percent of children with high cholesterol are being missed. And for some children, cholesterol-lowering drugs, called statins, may be their best hope for lowering their risk for early heart attack, proponents say.

"We are in an epidemic," says Dr. Jatinder Bhatia, a member of the academy's nutrition committee, which is making the recommendation, and professor and chief of neonatology at the Medical College of Georgia in Augusta. "The risk of giving statins at a lower age is less than the benefit you're going to get out of it."

Bhatia said that while there was not "a whole lot" of data on pediatric use of cholesterol-lowering drugs, recent research did show that the drugs were generally safe for children.

Surprisingly, the paper published in the medical journal Pediatrics that explains the new guidelines notes that among children, average total cholesterol levels as well as LDL and HDL cholesterol have remained stable, while triglyceride levels have dropped, based on data collected from 1988 to 2000.

It is not clear how many children would be affected by the new guidelines. The recommendations call for cholesterol screening of children and adolescents, starting as early as age 2 and no later than age 10, if they come from families with a history of high cholesterol or heart attacks before the age of 55 for men and 65 for women.

Screening is also recommended for children when family history is not known, or if they have other risk factors, like being at or above the 85th percentile for weight, if they smoke or have diabetes.

If the child's cholesterol level is normal, retesting is suggested in three to five years.

Although lifestyle changes are still recommended as the first course of action, drug treatment should be considered for children 8 years and older who have bad cholesterol of 190 milligrams per deciliter and who also have a family history of early heart disease or two additional risk factors, according to the new recommendations.

The guidelines give no guidance on how long a child should stay on drug treatment or whether it should be continued indefinitely.

While statins have been shown to lower risk for heart attack and death in middle aged men with existing heart disease, there is little evidence they prolong life in healthy men, women or people older than 70.

And because statins have been around only since the mid-1980s, there is no evidence to show whether giving statins to a child will lower his or her risk for heart attack in middle-age.