Some Children May Need Cholesterol Medication
< July 9, 2008 > -- A
leading group of pediatricians has released new guidelines that advise kids as
young as 8 years old should be given cholesterol-lowering medications in hopes
of preventing heart problems later in life.
The new recommendations come as a result of the reality of
rising rates of childhood obesity in the US.
The American Academy of Pediatrics
(AAP) also recommends that children as young as 2 years old start having
their cholesterol levels screened if they have a family history of heart disease
or high cholesterol. Screening should start no later than 10, the
AAP says.
The recommendations were published in the journal
Pediatrics.
Dr. Steven P. Shelov, chairman of pediatrics at Maimonides
Medical Center and head of Maimonides Infants & Children's Hospital in New York
City, says he agrees with the new guidelines.
"More aggressive screening is a good idea, and the use of
[cholesterol-lowering] statins at relatively low doses will keep cholesterol at
safer ranges," he says.
Statins are a group of antihyperlipidemic
(cholesterol-lowering) medications, and include simvastatin (Zocor®),
atorvastatin (Lipitor®), and pravastatin (Pravachol®), among others.
The AAP also recommends that
children whose family history of cholesterol is not known, or who have risk
factors for heart disease - including obesity, high blood pressure, or diabetes
- have their cholesterol tested.
Some 30 percent to 60 percent of US kids with high
cholesterol are falling through the cracks, being neither diagnosed nor treated.
According to the recommendation, the best method for
checking cholesterol is a fasting blood test. Children whose cholesterol is
normal should have the test repeated every three to five years.
For those children older than 8 who have high levels of LDL
(bad) cholesterol, doctors should consider giving them statins.
For younger children with high cholesterol, lifestyle
changes such as losing weight and increasing physical activity, as well as
nutritional counseling, should be considered.
Also, for children age one year and older who may be
overweight or obese, the AAP recommends giving
them low-fat dairy products such as 2 percent milk and other low-fat dairy
foods.
Dr. Shelov, who was not involved in drafting the
recommendations, says he is not overly concerned about giving statins to
children. Side effects are rare, and the benefits of the drugs make them worth
the risk, he says.
"The levels of obesity we are seeing and the unsafe level
of cholesterol now in our teenagers - even down as young as our fourth- and
fifth-graders - this recommendation appears to be well thought out," he says.
Dr. Shelov admits that very little is known about the risks
and benefits of using cholesterol-lowering drugs like statins in a large
pediatric population.
Potentially, millions of children could be placed on
cholesterol-lowering drugs, he says. "At the same time, there needs to be a
systematic look at the effects of these medications on children, because they do
have side effects," he adds.
"If we are going to go ahead and do this, we're going to
need guidelines on exactly who would warrant the therapy and careful measurement
of any side effects," Dr. Shelov says.
It is possible that many children who start taking statins
may not require them for life. Changes in diet and exercise could have some
children off the drugs in a relatively short time, Dr. Shelov says.
Always consult your physician for more information.
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Cholesterol is a waxy substance that can be found in
all parts of your child's body. It aids in the production of cell membranes,
some hormones, and vitamin D.
The cholesterol in blood comes from two sources: the
food your child eats and his/her liver. However, your child's liver makes
all of the cholesterol the body needs.
Cholesterol and other fats are transported through the
bloodstream in the form of round particles called lipoproteins. The two most
commonly known lipoproteins are low-density
lipoproteins (LDL) and high-density
lipoproteins (HDL).
LDL cholesterol is commonly called "bad " cholesterol.
It can contribute to the formation of plaque buildup in the arteries, known
as atherosclerosis.
LDL levels should be low. To help lower LDL levels,
help your child to:
- avoid foods high in saturated fat, dietary cholesterol, and excess
calories.
- increase exercise.
- maintain a healthy weight.
HDL cholesterol is known as "good" cholesterol, and is
a type of fat in the blood that helps to remove cholesterol from the blood,
preventing the fatty build up and formation of plaque.
HDL should be as high as possible. It is often possible
to raise HDL by:
- exercising for at least 20 minutes three times a week.
- avoiding saturated fat intake.
- decreasing body weight.
For some children, medication may be needed. Because
raising HDL can be complicated, you should work with your child's physician
on developing a therapeutic plan.
Physicians in the past felt that children were at
little risk for developing high cholesterol levels and other risk factors
for heart diseases affecting the coronary arteries and blood vessels until
later in life.
However, many physicians now realize that children are
increasingly at risk for having high blood cholesterol levels as a result of
one or more factors, such as sedentary lifestyles, high-fat junk food and
fast food diets, obesity, and family history of high cholesterol levels.
Always consult your child's physician for more
information.
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