AAP: Cholesterol Screening Is Urged for Young: statins

[Guest guest]

A physician's warning about statins follows the news article.

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Cholesterol Screening Is Urged for Young

By TARA PARKER-POPE

July 7, 2008

http://www.nytimes.com/2008/07/07/health/07cholesterol.html

The nation'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 were to be issued by the American Academy of

Pediatrics on Monday.

The push to aggressively screen and medicate for high cholesterol in

children is certain to create 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 the nation's

children overweight or obese, many doctors fear that a rash of early

heart attacks and diabetes is on the horizon as these children grow up.

Previously, the academy had said cholesterol drugs should be considered

in children older than 10 if they fail to lose weight after a 6- to

12-month effort. The academy estimated that under the current

guidelines, 30 percent to 60 percent of children with high cholesterol

were being missed. And for some children, cholesterol-lowering drugs,

called statins, may be their best hope of lowering their risk of early

heart attack, proponents said.

" We are in an epidemic, " said Dr. Jatinder Bhatia, a member of the

academy's nutrition committee who is a 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. "

Dr. Bhatia said that although there was not " a whole lot " of data on

pediatric use of cholesterol-lowering drugs, recent research showed 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 adolescents, 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 the age of 2 and no later

than the age of 10, if they come from families with a history of high

cholesterol or heart attacks before 55 for men and 65 for women.

Screening is also recommended for children when family history is

unknown, or if they have other risk factors, like being at or above the

85th percentile for weight, 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 all

children 8 years and older who have bad cholesterol of 190 milligrams

per deciliter, or for children who have bad cholesterol of 160

milligrams per deciliter or higher and a family history of early heart

disease or two additional risk factors, the new recommendations say.

The guidelines give no guidance on how long a child should stay on drug

treatment.

But they do say the first goal should be to lower bad cholesterol levels

to less than 160 milligrams or possibly as low as 110 milligrams in

children with a strong family history of heart disease or other risk

factors like obesity.

Because statins have been around since only the mid-1980s, there is no

evidence to show whether giving statins to a child will lower the risk

for heart attack in middle age.

The academy also now recommends giving children low-fat milk after 12

months if a doctor is concerned about future weight problems. Although

children need fat for brain development, the group says that because

children often consume so much fat, low-fat milk is now appropriate.

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1. My Life After Statins

Duane Graveline MD MPH

Former USAF Flight Surgeon

Former NASA Astronaut

Retired Family Doctor

http://www.spacedoc.net/life_after_statins.html