Published: July 15, 2008 10:43 pm         

‘Cholesterol drugs aimed at children

MONTGOMERY, Ala. (AP) - A new guideline by the American Academy of Pediatrics that some children as young as 8 be given cholesterol-fighting drugs is alarming, but necessary, according to Alabama’s state health officer.

The prospect of prescribing these drugs to 8-year-olds might be jarring to some parents, but what’s more worrisome is the bigger message, said Dr. Don Williamson.

“To me, it’s not, ‘Will 10,000 children be put on these medications?’ It’s that we are now contemplating adult intervention in 8-year-olds,” he said.

He said it calls attention to the alarming fact that so many young children have cholesterol issues at all.

“Elevated cholesterol in children used to be a phenomenon of inherited disorders of the metabolism, but today, most of the elevated cholesterol in children is associated with obesity and the consequences of diet,” Williamson said.

“Who would have imagined that today we would be doing cholesterol typing, HDL and LDL, on children? Fifteen years ago, we didn’t see this problem at all. That, to me, is the red flag that we have a huge problem.”

Just as importantly, the news also underscores the need for early intervention to reduce the long-term risk for cardiovascular disease, he said.

The American Academy of Pediatrics says the new guidelines, which include wider cholesterol testing for kids, are based on mounting evidence that damage leading to heart disease begins early in life, and that cholesterol-fighting drugs are generally safe for children.

The AAP’s earlier guidelines advised that cholesterol drugs should only be considered in children older than 10, and only after those children failed to lose weight.

Its previous cholesterol screening recommendations also were less specific and did not include targeted ages for beginning testing.

Now, cholesterol screening is recommended some time after age 2 but no later than age 10, at routine checkups. Weight loss is still the first course for overweight children with too little HDL, or “good” cholesterol, but medication is suggested for 8-year-olds who have too much LDL, or “bad” cholesterol, along with other risky conditions such as obesity and high blood pressure.

“It shows that the health risks we bear as children may directly impact our health as adults,” Williamson said. “Assuming they are correct — and it’s sad that we have to go in this direction — this opens up an entire new avenue for intervention.”

As recently as a decade ago, such recommendations from the AAP might have come as a shock to pediatricians, but not now, said Dr. Karen E. Doles of Professional Pediatrics in Montgomery, where cholesterol screening for children considered at risk is a regular practice.

“Definitely it would have been surprising, but obesity wasn’t as much of an issue at that time,” Doles said.

The new guidelines state that all children 8 and older with an LDL higher than 190 be started on cholesterol-fighting medicine, she said. But children who have an LDL level greater than 160 along with other risk factors — such as obesity or a family history of heart disease — — also should begin medication.

Williamson acknowledges that parents might be concerned about the safety of prescribing cholesterol-fighting drugs, known as statins, to 8-year-old children.

“Fortunately, statins are relatively well-tolerated, and the writers (of the guidelines) suggest that the drugs are generally safe for children,” he said. He added that as long as a pediatrician closely follows and monitors the child taking the medication, it will be safe, and it opens up the opportunity to prevent future heart disease.

The new guidelines also have advice for parents of children far younger than 8. For the first time, the AAP is recommending low-fat milk for 1-year-olds, specifically those who are at risk for obesity.

Williamson said that could be interpreted as an across-the-board recommendation.

“I think the point is that (the obesity risk) could logically extend to almost every 1 year old,” he said. This new guideline also represents a major change, he said, one that balances the benefits of reducing fat exposure with the fat exposure that a baby needs to remain healthy.

He said the new guidelines as a whole could be one catalyst for a more concentrated effort to keep children healthy.

“All parents want their children to be healthy,” he said. “This ... drives home for parents that obesity in children is not simply a cosmetic issue but can be associated with both immediate and lifelong health consequences.”

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Information from: Montgomery Advertiser, http://www.montgomeryadvertiser.com