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Controlling cholesterol in children

Some new drugs may have risks, but the risks may be worth taking. For other kids, diet and exercise are the better treatment.

March 01, 2010

Doctors may not agree on the need to screen children for high cholesterol, but those who do will likely want to treat kids with abnormal results.
Lifestyle interventions, especially dietary changes, form the foundation of any lipid treatment plan. Fat consumption should be reduced, with less than 10% of daily caloric intake coming from saturated fats and with trans fats eliminated completely if possible.
Exercise is also important. Even modest amounts of exercise, if performed regularly, can improve lipid levels.
Children who are overweight need to shed those extra pounds. Weight loss not only drives down levels of LDL, or "bad," cholesterol and triglycerides, it drives up levels of HDL, or "good," cholesterol.
Cholesterol-lowering medications are a last resort for kids. Drugs such as statins are typically considered in children only with genetic disorders that predispose them to exceptionally high cholesterol levels or children at risk of heart disease who fail to adequately control their levels with lifestyle modifications.
"We have a pretty clear idea that these medications are effective in lowering cholesterol and are safe," says Dr. Stephen Daniels, who co-wrote the American Academy of Pediatrics' 2008 report on lipid screening in children.
Currently, only one statin drug, pravastatin, is approved for use in children as young as 8. Many pediatricians are cautious about using such drugs because evidence of their safety when taken over an extended period of time has not been proved.
"The harder question is what can we say about children who might be on these medications for decades," Daniels says. Currently, none of the studies looking at safety extends beyond 24 months.
For now, most experts agree that for children at high risk of heart disease, the unknown risks of these medications are worth taking. For other children, diet and exercise are the way to go.
Valerie Ulene

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