Kids & Cholesterol: Call for Early Action

The growing recognition that the buildup of fatty plaque in
the arteries that can increase risk of heart attacks and strokes begins as
early as childhood has experts calling for earlier and more aggressive
treatment to reduce this risk.

Lifestyle and drug interventions aimed at
lowering cholesterol beginning in early adulthood and even childhood could
significantly reduce death rates from heart and vascular disease, the experts
concluded in an analysis appearing in the Aug. 5 issue of the American Heart
Association journal Circulation.

The current practice of prescribing cholesterol -lowering
statin drugs to mostly
middle-aged people who already have significant plaque buildup does not take
full advantage of the potential of these drugs, longtime cholesterol researcher
Daniel Steinberg, MD, PhD, of the University of California, San Diego tells

"The research tells us that [statin] treatment as it is currently given
reduces death and disability from
heart disease by about 30%," he says. "Our contention is that that
is a gross underestimate of the benefits we would see if we treated earlier and
more aggressively."

Young Children and Statins

Last month, the American Academy of Pediatrics (AAP) created a stir by
concluding that some children as young as age 8 may benefit from treatment with
cholesterol-lowering statin drugs.

Newly revised AAP guidelines recommend cholesterol screening for all
children who are
overweight or have diabetes or
high blood pressure , in addition to children with a family history of early
heart disease and high cholesterol.

While the first treatment should be lifestyle changes including healthy eating and plenty of exercise, the
guidelines now state that drug treatment "should be considered" even
for young children with extremely high
cholesterol levels , specifically:

  • LDL levels 190 mg/dL or higher.

  • LDL levels of 160 mg/dL or higher if there is a family history of heart
    disease or two other heart disease risk factors.

  • LDL levels of 130 mg/dL or higher if the child has type 1 or
    type 2 diabetes .

"Study after study, in both adults and kids, has shown that multiple
risk factors accelerate the process of plaque buildup in the arteries known as
atherosclerosis," pediatrics professor Stephen R. Daniels, MD, PhD, tells

Daniels, who is chairman of the department of pediatrics at the University
of Colorado, Denver School of Medicine, was a principal author of the revised
AAP guidelines. He is also a spokesman for the American Heart Association.

Daniels says only a tiny percentage of children have LDL levels high enough
to make drug treatment an option, but he agrees that earlier treatment could
have long-term benefits.

"Pediatricians and family physicians should be aware that
atherosclerosis can begin very early in life leading to heart disease much
earlier in adulthood," he says. "Early lifestyle interventions, and
possibly drugs, can reduce this risk."

Cholesterol-Lowering Strategy for Kids

In their analysis, Steinberg and University of California, San Diego
colleagues Christopher K. Glass, MD, PhD, and Joseph L. Witztum, MD, call for
more aggressive cholesterol-lowering strategies for both children and young

Current guidelines call for adults with high risk for heart attacks and
other cardiac events to strive for an LDL level of 70 mg/dL or below, but the
three researchers argue that 50 mg/dL or below may be a more appropriate

"That goal is currently attainable in many patients with the treatment
regimens now available, which include statins alone or in combination with
other [cholesterol-lowering] drugs," they write.

With regard to lifestyle interventions, the researchers advocate a
diet low in saturated fat and cholesterol for everyone, including babies as
youn as 7 months.

Until last month, the AAP recommended that children between the ages of 1
and 2 drink only whole milk, but the new guidelines do not include this

"The idea was to give pediatricians a little more flexibility,"
Daniels says. "Recommending whole milk should be a judgment call based on
considerations like family [heart disease] history and obesity."

By Salynn Boyles
Reviewed by Louise Chang
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