While some experts have recently recommended more aggressive cholesterol screening in childhood, less than 1 percent of adolescents 12–17- years-old may potentially qualify for cholesterol-lowering drugs, according to a new study published in Circulation: Journal of the American Heart Association.
According to the study, updated recommendations for cholesterol screening in childhood released last year by the American Academy of Pediatrics (AAP) has drawn new attention to the importance of healthy cholesterol concentrations in children and adolescents.
“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,” said Earl S. Ford, M.D., M.P.H., lead author of the study and medical officer in the United States Public Health Service. “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.”
Ford and colleagues studied the National Health and Nutrition Examination Survey 1999 to 2006, a database of health information, including cholesterol levels, for a national sample of people of all ages.
The researchers reviewed information on nearly 10,000 participants ages 6 to 17, including about 2,700 adolescents ages 12 to 17 who had fasting low density lipoprotein (LDL) levels measured.
• The average LDL level was 90.2 milligrams per deciliter (mg/dL) and the average total cholesterol was 163 mg/dL — both considered acceptable levels.
• Total cholesterol levels were 3.6 mg/dL higher in girls compared to boys.
• Total cholesterol levels were 2.6 mg/dL higher among African Americans and 1.9 mg/dL lower among Mexican Americans when compared with whites.
• The higher concentrations of total cholesterol for girls start to emerge around age 14.
The AAP guidelines suggest that cholesterol drugs, or statins, be considered for children as young as 8-years-old, if a screening shows their cholesterol levels are at or above accepted levels.
For example, cholesterol drugs, or statins may be considered for children who have:
• other risk factors present including obesity, hypertension, or cigarette smoking or positive history of premature cardiovascular disease and cholesterol levels greater than 160 mg/dL; or
• diabetes with cholesterol levels equal to or greater than130 mg/dL.
Based on approaches presented in the AAP guidelines to define elevated concentrations of LDL and total cholesterol by age and gender, researchers found 5.2 percent to 6.6 percent of adolescents had an elevated concentration of LDL cholesterol and 9.6 percent to 10.7 percent had elevated total cholesterol.
However, when researchers calculated how many of these adolescents were eligible for pharmacologic management of their cholesterol, based on AAP established guidelines, they found 0.8 percent or 200,000 adolescents ages 12 to 17 were potentially eligible.
“It is a matter of opinion whether one thinks 0.8 percent is a small or large percentage,” Ford said.
“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. Having high cholesterol levels in childhood will affect the future rates of cardiovascular disease among U.S. adults.”
American Heart Association guidelines call for selective screening in children with a family history of high cholesterol and early heart disease, but recommends that the first line of treatment for these children would be lifestyle changes to encourage healthier eating and more physical activity.
Continued research is needed in the area of drug therapy for high-risk cholesterol abnormalities in children, particularly research on its long-term efficacy, safety and impact on the atherosclerotic disease process, Ford said.

ScienceDaily (Jan. 26, 2009)
— Americans who use illegal diet pills from South America may be taking amphetamines without knowing it and seriously risking both their health and their jobs. Physicians need to be made aware of the range of serious side effects of these drugs to allow them to identify and treat those patients presenting with unexplained symptoms.
These findings, by Dr Pieter Cohen from the Department of Internal Medicine at the Cambridge Health Alliance in the US and Harvard Medical School, have recently been published online in Springer’s Journal of General Internal Medicine.
Although the US Food and Drug Administration (FDA) has banned the majority of amphetamine-based appetite suppressants, many are still prescribed in other parts of the world, including South America. The second most often prescribed amphetamine based appetite suppressant worldwide is fenproporex. It is known to be addictive and is rapidly converted into amphetamine in the body. The international availability of fenproporex, combined with Internet sales and other illegal markets, have led to its availability in the US, despite an FDA ban. Most physicians in the US are unaware of the existence of these diet pills combining fenproporex and benzodiazepines, selective serotonin reuptake inhibitors, diuretics, laxatives, thyroid hormones and other substances.
To illustrate the risks posed by taking these diet pills, Dr Cohen reviews two case reports of patients taking appetite suppressants containing fenproporex, illegally imported from Brazil. In the first case, a 26-year-old woman suffered from intermittent chest pains, palpitations, headaches and insomnia for two years. She consulted her doctor numerous times over the two-year period for these unexplained symptoms. Her urine tested positive for amphetamines and benzodiazepines, and both fenproporex and chlordiazepoxide were present in her pills. Her symptoms disappeared after she stopped taking the imported pills.
In the second case, a 38-year-old man tested positive for amphetamines after an occupational urine screening test and was suspended from work. Both fenproporex and fluoxetine were detected in his imported pills. While he was taking the pills he also experienced insomnia and palpitations, symptoms which disappeared after he stopped taking the pills. In both cases, not all the substances detected in the pills matched the ingredients on the vial labels.
Because of the ease of availability of these diet pills over the Internet amongst others, the health and economic consequences of diet pill use are likely to be widespread within certain communities in the US, according to Dr Cohen. He recommends that physicians be made aware of the composition and dangers of the fenproporex-based diet pills imported from South America.
He concludes that “Given the wide variety of potential adverse effects from the medications included in these diet pills, patients attempting to lose weight who experience unexplained symptoms should be specifically questioned regarding the use of imported diet pills.”
Cohen et al.
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, 2008; DOI:

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.

The Food and Drug Administration is warning people who may want to lose weight in the new year. WFMZ’s Melissa Batulis has more on a list of what may be hidden in your diet plan.
  REPORTER: They’re weight loss products that claim to be herbal or healthy. But it’s what they don’t say that has federal regulators and doctors worried. 
BANEY: At worst, could kill you. 
REPORTER: The FDA released a list of 25 weight loss pills including 7 Day Herbal Slim, Phyto Shape and Somotrim. The concern is that these products contain, but leave off their labels ingredients like a suspected carcinogen, drugs not approved in the U-S and even prescription medication. 
BANEY: Phenytoin is actually a medicine used for people who have seizures.
REPORTER: Dr. Philip Baney at Laureldale Family Medicine says he discourages his patients who want to lose weight from taking any kind of medicine to do so. 
BANEY: My first answer is the best way to lose weight is diet and exercise. 
STAND UP: Some of these products mimic the claims of FDA approved drugs. Slim Express promises to prevent the digestion of dietary fat. Dr. Baney says the over the counter drug Alli was approved by the FDA and does help block fat, but it still comes at a price. 
BANEY: Most folks don’t like that because it has some very unpleasant gastrointestinal side effects if you were to take that drug and then ingest a lot of fat. 
REPORTER: As for the pills in question, the FDA is in the process of investigating the companies that sell them…and product recalls are in the works. In the meantime, if you’ve taken any of those products, the FDA recommends you see your doctor. And Dr. Baney recommends that if you want to lose weight, make sure you’re ready to make that commitment. 
BANEY: If someone just wants a pill, chances are they’re not seriously ready to make the changes they need to get a healthy weight loss and maintain that. 
REPORTER: Melissa Batulis, 69 News Berks Edition.