For 20 years, statins have been shown to be largely safe and effective, with no cumulative side effects, for adults. "What we don't know is, over decades, how safe they are for children," says Dr. Alan Lewis of Childrens Hospital Los Angeles. "We're all cautious about extrapolating data from adults to children, but that's all we have available."
For some children, statins are the only option.
Probably fewer than 1% of American children have a genetic predisposition to extremely high levels of cholesterol, a condition called hypercholesterolemia. Their childhood blood levels can soar to 500 mg/dL of total cholesterol, putting them at risk of heart attacks as early as in their 20s or 30s. These high-risk kids can develop fatty deposits in arterial walls that evolve during their teens into dangerous plaque deposits. They are prime candidates for early statin use.
And for some children -- even without a genetic predisposition to very high cholesterol -- lifestyle modifications will prove unworkable or not effective enough. Those most likely to have high cholesterol include kids with a family history of early heart disease or risk factors such as obesity, high blood pressure or diabetes.
Dr. Peter Belamarich, a pediatrician at the Children's Hospital at Montefiore in New York City, has prescribed statins to children. But he has concerns that the new guidelines will encourage more statin use even among kids who are not at highest risk. It may send a message that there is a magic pill to cure their ills.