July 11, 2008
Pediatricians Say Some Kids May Need to Lower Cholesterol With Medication
By Jan Jarvis?, Fort Worth Star-Telegram, Texas
Jul. 11--Beverly Morgan of Arlington was 16 when she started taking the popular cholesterol-lowering drug Vytorin.But she eventually abandoned the medication.
"I would rather control my cholesterol with exercise and diet simply because when you do put drugs in your body, you're going to have side effects," said Morgan, 19, a student at Mountain View Community College in Dallas. "I try to take as little medications as possible."
While many people share Morgan's reluctance to use drugs to lower cholesterol, others consider the statins to be lifesavers. Under new guidelines from the American Academy of Pediatrics, children as young as 8 who are at high risk of heart disease would take the medications to reduce cholesterol. Screening should begin at age 2 and no later than age 10 for children with a family history of heart disease and other risks such as diabetes and high blood pressure.
Four prescription drugs have pediatric labeling from the Food and Drug Administration based on clinical trials involving children. In 2002, lovastatin became the first statin for use in children.
Not for everyone
No one is saying every child with high cholesterol needs to be on medications, but there are some who really do need to be treated aggressively, said Dr. Sarah Blumenschein, a pediatric cardiologist and associate professor at the University of Texas Southwestern Medical Center at Dallas. One in 300 children has a family history of high cholesterol.
"If Dad had a heart attack at 32, and you have an 8-year-old boy with a cholesterol level of 300, you want that person to be in a very safe place by the time they are 10," she said. "Statin drugs are the way to do that."
While some children can reduce cholesterol levels without medication, others simply cannot. They have high cholesterol -- sometimes 600 or more -- and it has nothing to do with exercise or what they eat, said Dr. Benjamin Siu, a pediatric cardiologist at Cook Children's Medical Center.
A child with an abnormal lipid profile and diabetes, hypertension or a family history can try exercise and diet first, he said. But by age 10 or 11 that child may need to be on medication, he said. And he or she will need it for a lifetime.
"If you don't treat it, you have a calculatable risk," he said. "We do have heart attacks in young people who are in their 20s and 30s."
Risks and alternatives
The trouble is that the medications carry their own risks, said Dr. Maria Fisher, an Arlington pediatrician who runs a fitness clinic for overweight children. As a member of the American Academy of Pediatrics, she supports the recommendations, but she prefers to use diet and exercise to reduce cholesterol.
"I have some concerns with treating kids with lipid-lowering drugs because there is a risk of liver damage," she said. "These are just kids, and these are adult medications."
Children are not static like adults, Fisher said. Their livers are constantly changing and maturing. She also questions what the long-term effects will be if children take the drugs over a lifetime.
"Unfortunately, only time will tell," she said.
The idea of Beverly Morgan taking statins for life didn't set well with her mother, Dorothy.
"My feeling is to always try exercise before drugs because I just don't trust the pharmaceuticals," Dorothy said. "Most of these drugs are relatively new, and I was concerned that the effect on a teenager's body would be different."
At least eight to 10 clinical trials have looked at statin use among young people, and there are about 12 years of follow-up study, Siu said.
"We know that the statins are generally safe and do not have a significant impact on growth and sexual maturity," he said.
"Adverse events still occur in children. However, we have not had any irreparable liver or muscle damage."
To reduce the risks, children are closely monitored for liver damage and muscle problems.
For children at risk of heart disease, the statins offer benefits beyond lowering cholesterol. They can also protect the lining of the blood vessels, Blumenschein said.
"It's like putting furniture polish on the dining room table to protect it," she said. "The statin drugs do exactly that."
With one-third of children obese or overweight, there's a need to screen for high cholesterol and address the problem early in life, Blumenschein said.
The best time to start treatment is during childhood, when parents can still get children on a program that in the end could save their lives. Once they turn 18, parents have almost no control over them, Blumenschein said.
"The idea is early treatment to prevent these disasters that occur at 30, 40 or 50 when they just drop over dead," she said.
Lipid screening and treatment for high cholesterol The American Academy of Pediatrics recommends:
Screen cholesterol after age 2 but no later than age 10 for children with a family history of heart disease or other risk factors including obesity, high blood pressure or diabetes.
The best method for testing is fasting lipid profile.
If a child's values are normal, the test should be repeated in three to five years.
For children over age 8 with high LDL concentrations, cholesterol-reducing medications should be considered.
Younger patients should focus on weight reduction, increased activity and diet.
Children as young as 1 year old with weight concerns should use reduced-fat dairy products such as 2 percent milk.
Source: American Academy of Pediatrics
Total cholesterol levels for children ages 2-19 Acceptable -- under 170
Borderline -- 170-199
LDL levels for children ages 2-19 Acceptable -- under 110
Borderline -- 110-129
High -- 130 or greater
Source: American Heart Association
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