Less Children Need Cholesterol Drugs

By Margarita Nahapetyan

A new study published in the journal Circulation reports that less than 1 per cent of American teenagers are likely to need medication to lower their cholesterol levels.

Cholesterol is a major risk factor for heart disease and stroke. High cholesterol can lead to a buildup of plaque in the artery walls, narrowing a person's arteries, and making it more difficult for blood to flow through the heart and body. There is a lot of evidence that plaque buildup begins in childhood.

Last year, the American Academy of Pediatrics (AAP) suggested that cholesterol-lowering drugs, called statins, should be considered for kids 8 years of age and older with "bad" cholesterol levels, or LDL, greater than 190 reading, and with a family history of heart disease. Additionally, drug treatment was suggested for a 130 or higher reading for youngsters with diabetes or a 160 reading for kids with other risk factors, such as obesity or smoking.

"I think the new recommendations caused a lot of people to be concerned about children having high cholesterol and being put on medications for a good part of their lives," Earl S. Ford, MD, MPH, a lead author of the study and medical officer in the United States Public Health Service, said in his statement. "In this study, we set out to produce numbers so we would know exactly what we are talking about in terms of the percentages of U.S. children who may need to be treated or may have high cholesterol levels."

For their new study, Ford and his team looked at data from nearly 10,000 children aged 6 to 17, who participated in the National Health and Nutrition Examination government survey from 1999 to 2006. Of all the children, about 2,700 aged 12 to 17 had their LDL levels measured. The analysis showed that the children's average LDL and total cholesterol levels were both among acceptable levels.

After that all the numbers were checked against the AAP guidelines, considering other factors that should be taken into account while recommending medication. A little more than 5 per cent to nearly 7 per cent of the adolescents had high LDL cholesterol, 9.6 per cent to 10.7 per cent had high total cholesterol, and 0.8 per cent were found to be in need for statin treatment. Based on the fact that there are almost 25 million adolescents in the United States, these findings suggest that 200,000 individuals between the ages of 12 and 17 need statins to keep their levels of cholesterol in norm.

The study also revealed that the girls who took part in the study had higher total cholesterol levels than boys, and that the increases in total cholesterol in girls started showing by the age of 14. The researchers also found that white people had lower total cholesterol levels than African-Americans, but higher than Mexican-Americans.

"It is a matter of opinion whether one thinks 0.8 per cent is a small or large percentage," Ford says. "What I think is most important here is that given the rise in childhood obesity and risk factors such as smoking and lack of exercise that adolescents are exposed to, we need to continually assess and monitor the lipid status of children and adolescents."

The AAP agrees with that approach, said Dr. Stephen R. Daniels, chairman of pediatrics at the University of Colorado at Denver, and a lead author of the guidelines. "It is true for adults but especially true for children," Daniels said. "Clinicians should maximize their efforts on lifestyle factors before any consideration of medication."

Daniels also added that the increase in obesity does not seem to be bringing an increase in cholesterol levels. "The concern was I think, because there is an increasing level in obesity, that it would lead to higher and higher cholesterol levels. They do not seem to be going up," he said.

Both American Academy of Pediatrics and American Heart Association guidelines strongly recommend a selective screening in children with a family history of high cholesterol and early heart disease. Number one treatment for such children should be change in a lifestyle, such as healthy diet and more physical activity, the guidelines say.

The study does not provide any specific information for one of the most worrying issues of the new pediatrics guidelines - that some children as young as 8 years old might need cholesterol-fighting drugs. LDL readings for children under the age of 12 were unavailable.

However, Dr. Ford believes that there is a probability that the results from the older group of participants may apply to the younger children as well.