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.

Doctors have known that some children and adolescents taking stimulant medications for attention deficit hyperactivity disorder experience psychiatric symptoms from the drugs, such as hallucinations, hearing voices, paranoia and mania. In 2007, the Food and Drug Administration ordered manufacturers of stimulant medications to add new warnings about psychiatric and cardiovascular side effects to package inserts. And patient medication guides are also required to explain the risks of ADHD drug treatments. At the time of the FDA order, experts estimated the risk of an adverse psychiatric event from medication use at about 1 in 1,000 children.
, however, estimates the incidence of psychotic symptoms at 1.48 per 100 person-years. (Person-years is defined as total years of treatment with a drug. For example, 100 people taking a drug one year is 100 person-years.) The statistic was based on data from 49 randomized, controlled trials of ADHD medications. In those same studies, no psychotic symptoms were reported in children who did not receive medication. Moreover, an analysis of spontaneous adverse-event reports to the FDA showed more than 800 reports of psychosis or mania. Psychotic symptoms were found with every ADHD drug tested.
Just under 8% of U.S. children, ages 4 to 17, have been diagnosed with ADHD, according to a survey conducted in 2003 by the Centers for Disease Control and Prevention. More than half of these children were taking a medication for the disorder. However, the research reported today shows that psychotic symptoms occurred even in children who were not considered at high risk for psychosis or mania, such as children who abuse drugs or have other mental illnesses. In more than 90% of the cases, the children had never experienced hallucinations or psychosis. In most cases, the hallucinations were visual and tactile and involved seeing or feeling bugs, worms or snakes. The symptoms typically disappeared after the children stopped taking ADHD medication.
It’s not clear just why some children experience psychotic reactions to the drugs or what causes the symptoms. However, doctors should explain to parents that any psychosis or mania that occurs during treatment could be from the drug itself, said the authors of the report. And, they add, their paper is fresh evidence regarding the limitations of short-term clinical trials. The clinical trials of stimulant drugs showed a much lower rate of psychotic symptoms, but it wasn’t until the medications were widely prescribed in a broad range of people that psychotic adverse events became prominent.

Metabolic syndrome in adults occurs when they have at least three risk factors from among abdominal obesity (waist circumference more than 35 inches for women; 40 inches for men); low HDL (“good”) cholesterol; high triglycerides; high fasting glucose; and high blood pressure.
Although sometimes difficult to diagnosis in children, similar clustering can appear in childhood. The report, published online Jan. 12 in
, called for clinicians to measure and to treat the individual pieces of the syndrome in children while intervening to break bad diet and exercise habits.
“The adverse risk factors and the connections between them that eventually lead to the metabolic syndrome begin in childhood,” Dr. Julia Steinberger, director of Pediatric Echocardiography and Preventive Cardiology at the University of Minnesota Children’s Hospital in Minneapolis, said in an American Heart Association news release. She chaired the group that wrote the report.
Much of the increased risk is tied to the continued increase in childhood obesity, which the heart association said is around 17 percent of all children aged 6 to 19. Having a body-mass index at or above the 95th percentile for the child’s age is considered being obese.
“We can say that childhood obesity is our biggest problem,” Steinberger said. “It’s been shown that when diet and exercise are improved in overweight children, the structure and function of blood vessels improves even in the absence of weight loss.”
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SOURCE: American Heart Association, news release, Jan. 12, 2009

Think about what you had for lunch: Was it a hamburger? A chicken sandwich? Barbecue? What about vegetables? Would it surprise you to learn that what you eat can affect the whole planet?
It can — in a big way. Last week, scientists attending the American Association for the Advancement of Science meeting in Chicago presented new studies showing how food and its production affect the globe and its warming climate. The researchers had some bad news for meat-eaters (which is good news for cows!). They also offered some suggestions for how to eat in a more environmentally friendly way.
You’ve probably heard of global warming: For many years, scientists have warned that our planet is getting warmer. If current trends continue, then animals may start to die off and life could get very difficult for everyone. The temperature is on the rise because for more than a century, human kind has been releasing massive amounts of gases into the atmosphere, called “greenhouse gases.” These gases surround the planet and keep heat from escaping the atmosphere. You can think of them as a blanket for the Earth that traps heat. One of these greenhouse gases is carbon dioxide.
What does this have to do with food? A big chunk of the carbon dioxide that we put in the atmosphere every year comes from the process of making and eating food, the scientists reported in Chicago. The production of meat contributes a lot of that carbon dioxide. And much of meat’s contribution comes from beef, which is responsible for releasing even more warming gases into the atmosphere.
The process of making a hamburger, for example, requires a lot of energy. A cow has to be fed and raised on farmland, and cow manure is a major source of methane — an especially potent greenhouse gas. The cow has to be slaughtered. The meat has to be processed and shipped to a consumer, which takes fuel. Most of the cow won’t even be used for meat that people eat.
By the time a hamburger finally lands on a dinner plate, it has taken a heavy toll on the environment. According to Ulf Sonesson of the Swedish Institute for Food and Biotechnology in Goteborg, Sweden, the process of making a one half-pound all-beef burger adds the equivalent (made up of other greenhouse gases) of about 19 times that hamburger’s weight in carbon dioxide.
The message from the research is clear: We can drastically reduce the production of global-warming gases by eating less beef. (That’s healthier, too, since Americans eat twice as much beef as is advised by the U.S. Department of Agriculture.) Other kinds of meat like pork and chicken do less harm to the environment — at least in terms of the amount of greenhouse gases released. Nathan Pelletier, a scientist Dalhousie University in Canada, reported that if everyone in industrial countries (like the United States) substituted chicken for beef, we would cut meat’s contribution in these countries to the greenhouse warming of Earth’s air by more than half.
All kinds of meat, the scientists reported, are harder on the planet than vegetables. To grow and eat a pound of potatoes, for example, sends less than one quarter-pound of carbon dioxide or equivalent warming gases into the air. So shifting our diet to less meat and more vegetables, as it turns out, may do the world some good.
Chemical compounds found in the Earth’s atmosphere that allow sunlight to enter the atmosphere freely. When sunlight strikes the Earth’s surface, some of it is re-radiated back towards space as heat. Greenhouse gases absorb this infrared radiation and trap the heat in the atmosphere.
A colorless, odorless, incombustible gas made up of one carbon and two oxygen atoms.
An odorless, colorless, flammable gas that is the major constituent of natural gas.
The gaseous mass or envelope surrounding a celestial body, especially the one surrounding the earth, and retained by the celestial body’s gravitational field.
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