Children eight years of age or older should be treated with cholesterol medication if they are found to have high levels of low-density lipoprotein (LDL), or so-called bad cholesterol, a new report says.
The new recommendation from the American Academy of Pediatrics is a drastic step toward preventing cardiovascular disease among at-risk children, including those with high cholesterol.
CTV medical consultant Dr. Marla Shapiro said the recommendation to medicate kids with cholesterol drugs should not come as a surprise, given the dramatic rise in obesity among children.
"We're at the point where a large, respected pediatric society, which happens to be the American Pediatric Society, is taking a stand and really saying that with the rising epidemic of obesity, we know that in youth and young children this will translate into premature heart disease and stroke in the years to come," Shapiro told CTV Newsnet.
The report recommends cholesterol-lowering drugs for:
- Children with LDL levels of 190 mg per decilitre or higher.
- Children with an LDL reading of 160 mg per decilitre or higher, along with two heart disease risk factors in addition to a family history of early heart disease.
- Children with a reading of 130 mg per decilitre of LDL in addition to having diabetes.
The report says that cholesterol screening should be done after the age of two, but before the age of 10.
The recommendations are found in a report by the AAP, entitled Lipid Screening and Cardiovascular Health in Childhood. It is published in the July issue of Pediatrics.
While the report has been issued by American doctors, physicians in Canada say the results apply to all children.
"There have been a number of studies that have shown if you treat a child with high cholesterol levels that you can reverse the build up in their arteries even at a very young age," Dr. Brian McCrindle of Toronto's Hospital for Sick Children told CTV News.
However, Dr. Richard Tytus, a family physician in Hamilton, Ont., says that while cholesterol drugs are generally safe for children, the long-term effects of them are not yet known. As well, children will learn the lesson that a pill can be a quick fix for any problem.
"My point is let's not treat the symptoms, let's treat the cause," Tytus told CTV News.
The report's recommendations also include:
- Cholesterol screening for children who have a family history of heart disease risk factors such as obesity, high blood pressure or diabetes.
- Cholesterol screening for children with unknown family medical history.
- Lifestyle changes, such as an improved diet and an increase in physical activity, for reducing high cholesterol in children younger than eight.
- Another test, within three to five years, if a child's LDL levels are within a normal range.
Shapiro said that in Canada, doctors are already screening children for high cholesterol, particularly if they have a family history of the condition.
"But now we're saying that we should emphasize looking at children as individuals regardless of family history," Shapiro said. "If they themselves carry an individual risk, that's something that we should be looking at."
With a report by CTV medical specialist Avis Favaro and senior producer Elizabeth St. Philip
Abstract:
Lipid Screening and Cardiovascular Health in Childhood
Stephen R. Daniels, MD, PhD, Frank R. Greer, MD and the Committee on Nutrition
This clinical report replaces the 1998 policy statement from the American Academy of Pediatrics on cholesterol in childhood, which has been retired. This report has taken on new urgency given the current epidemic of childhood obesity with the subsequent increasing risk of type 2 diabetes mellitus, hypertension, and cardiovascular disease in older children and adults. The approach to screening children and adolescents with a fasting lipid profile remains a targeted approach. Overweight children belong to a special risk category of children and are in need of cholesterol screening regardless of family history or other risk factors. This report reemphasizes the need for prevention of cardiovascular disease by following Dietary Guidelines for Americans and increasing physical activity and also includes a review of the pharmacologic agents and indications for treating dyslipidemia in children.
