How Many Kids Need Cholesterol Drugs?
Feb. 16, 2009 — Following a call for more aggressive screening and
treatment of cholesterol in childhood, a new study published in the journal
shows that about 200,000 U.S. teens and preteens need
medication to lower their cholesterol.
The American Academy of Pediatrics (AAP) recommended last summer that
doctors consider cholesterol-lowering drugs, called statins, for children aged
8 and older if a blood test shows they have high cholesterol, particularly if
they have a family history of heart disease. Specifically, the AAP guidelines
state that statin therapy should be considered for children with low density
lipoprotein (LDL) “bad” cholesterol levels greater than 190 mg/dL. In
addition, drug treatment is recommended for lower LDL levels if certain
cardiovascular risk factors such as diabetes or obesity are present.
“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, lead author of the study and
medical officer in the United States Public Health Service, says in a
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.”
How Many Kids Really Need Statins?
For the current study, Ford and colleagues reviewed information from the
National Health and Nutrition Examination Survey 1999 to 2006. The review
included records from nearly 10,000 children aged 6 to 17 who had a total
cholesterol value assessed, including nearly 2,800 adolescents aged 12 to 17
who had a fasting blood test to measure their LDL level.
The analysis showed that the children’s average LDL and total cholesterol
levels were both among acceptable levels.
However, 5.2% to 6.6% of the adolescents had high LDL cholesterol, 9.6% to
10.7% had high total cholesterol, and 0.8% qualified for statin treatment based
upon the AAP guidelines. Given that there are about 25 million adolescents in
the U.S, these data suggest that 200,000 individuals between ages 12 and 17
need statins to keep their cholesterol levels in check.
“It is a matter of opinion whether one thinks 0.8% 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.”
Girls in the study had higher total cholesterol (3.6 mg/dL greater) levels
than boys.
The increases in total cholesterol in girls started to appear around age
14.
Whites had lower total cholesterol levels than African-Americans, but
higher than Mexican-Americans.
Ford says continued research is needed to determine the long-term safety and
effectiveness of cholesterol-lowering drugs in children.
Cholesterol is a waxy substance that can build up on the inside of blood
vessels. Over time, it can form into a hard substance called plaque, which can
clog arteries and increase your risk for heart attack and stroke. Growing
evidence shows that plaque buildup begins in childhood.
“Having high cholesterol levels in childhood will affect the future
rates of cardiovascular disease among U.S. adults,” Ford says.
The American Heart Association recommends lifestyle changes — such as
increased exercise and healthier eating — as the first line of treatment for
children who have high cholesterol.