To critics, this would lead to a slippery pharmacological slope: Instead of controlling kids' cholesterol through lifestyle changes (such as improved diet and exercise), the new guidelines would encourage a "quick fix" using drugs that have only undergone rigorous testing for safety and efficacy in adults.
The authors of the AAP guideline, for their part, argued that the statement urged a healthy diet and physical activity as a first line of treatment for children at risk for cardiovascular disease, and that the statin recommendation was only for children with a very high level of cholesterol, usually caused by genetic factors, or those for whom family history is not known or who have other cardiovascular disease risk factors, such as obesity, hypertension, cigarette smoking or diabetes.
"The levels that we are talking about cannot be reached by bad eating," says Nicolas Stettler, MD, assistant professor of pediatrics and a childhood obesity specialist at the University of Pennsylvania School of Medicine. "In adults, you may see cholesterol problems related to weight, but in kids, extremely high cholesterol is caused by family history, not obesity."
As for the charge that the effects of statins on kids' still-developing bodies is unknown, Dr. Stettler says that preliminary studies have shown that more than 95% of kids don't develop side effects, and studies on adults have shown no difference in side effects between long-term use and short-term use.
But disagreement continues, particularly, with respect to the potential long-term effects of statins, which are not well-studied. Skeptics note that we can't assume long-term statin use will affect children in the same way as it does adults.
Keeping Kids' Cholesterol Levels Healthy
The controversy has had at least one positive effect: It's gotten people talking about the epidemic of obesity that's threatening children's health today. To help a child maintain a healthy weight and cholesterol level, doctors advise the following:
- Offer smart food choices. Limit high-fat and high-sugar foods, offer lots of low-fat, high-fiber foods, such as oats, whole grains, vegetables and fruits. The recommendations provided in the AAP statement call for low-fat dairy products after age 2 (starting at 12 months for obese children or for children at high risk for cardiovascular disease).
- Encourage exercise. Get kids outdoors and active, whether it's biking, running or playing. Limit screen time in front of the TV or computer.
- If your child is at-risk for heart disease, have his or her cholesterol levels checked with a lipid panel.
According to the AAP statement, cholesterol screening is recommended for children with a strong family history of heart disease -- a parent, aunt, uncle or grandparent with high cholesterol or early cardiovascular disease -- as well as those who have other risk factors -- in particular, high blood pressure, overweight/obesity, cigarette smoking and/or diabetes. For such children, the AAP recommends cholesterol testing at age 2 and, if levels are normal, every three to five years thereafter. In addition, the AAP recommends cholesterol testing for children whose family history is not known.
If your child has unhealthy cholesterol levels, discuss the options for early intervention with your pediatrician.
Sources:
Daniels, S.R., F.R. Greer, and the Committee on Nutrition. "Lipid Screening and Cardiovascular Health in Childhood." Pediatrics 122(2008): 198-208. 1 Oct. 2008. <http://pediatrics.aappublications.org/cgi/content/full/122/1/198>.
de Ferranti, Sarah, and David S. Ludwig. "Storm Over Statins -- The Controversy Surrounding Pharmacologic Treatment of Children." The New England Journal of Medicine 359(2008): 1309-1312. 1 Oct. 2008. <http://content.nejm.org/cgi/content/full/359/13/1309>.
Stettler, Nicolas, M.D. Telephone interview. 29 Sep. 2008.
