Use of statins in children is debated
A recommendation by the American Academy of Pediatrics that those as young as 8 be aggressively treated with cholesterol-lowering drugs is creating controversy.
A recommendation from an influential doctors group that some children as young as 8 be aggressively treated with cholesterol-lowering drugs has triggered debate over whether there is enough scientific evidence to justify such a move.
Statins, already among the most widely prescribed drugs, have been shown to lower the risk of heart disease in certain adults. But there are no comparable long-term studies for children.
"We don't know the risks and the benefits," said Dr. Beatrice A. Golomb, a cholesterol expert at UC San Diego. "We don't really know the impact of long-term use."
The authors of the recommendation from the American Academy of Pediatrics concluded there was enough indirect evidence to suggest that starting treatment early makes sense in children with very high levels of cholesterol.
"The process that ends with a heart attack or stroke starts in childhood, even infancy," said Dr. Nicolas Stettler, a coauthor and pediatrician at the Children's Hospital of Philadelphia.
"The longer you slow down the process, the more you delay the progression," he said.
The guidelines, released Monday, are in response to the high rate of obesity among U.S. children and concerns that they could face increased risk of heart disease as adults.
The guidelines advise cholesterol testing for millions of children ages 2 to 10 who have a family history of early heart disease or other risk factors such as obesity or high blood pressure. Under the guidelines, those 8 and older should be considered for medication if they have a concentration of LDL, the so-called bad cholesterol, greater than 190 milligrams per deciliter.
The threshold drops to 160 milligrams per deciliter in children with a family history of heart disease or more than two other risk factors. In children with diabetes, the threshold for drug treatment is 130 milligrams.
Experts said those levels occurred only in children with a genetic predisposition to high cholesterol, including many who were of normal weight, and that under the guidelines, fewer than 1% of children would be considered for statins.
Children with these extremely high LDL levels are known to have an increased risk of heart disease later in life.
But some doctors predicted that the guidelines would lead to the use of drugs in children with only moderately high cholesterol levels.
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