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When Dr. Earl S. Ford read that the American Academy of Pediatrics (AAP) was recommending that children as young as eight be given cholesterol-lowering statins, he decided to check on the numbers.
His study, published in the online medical journal Circulation concludes that less than 1 percent of American children ages 12 to 17 meet the criteria for taking those drugs.
Dr. Ford is a medical officer in the US Public Health Service, but his reaction to the recommendation was the same as many parents: puzzlement.
"I remember that after the guidelines came out, there were a lot of media stories about them," says Dr. Ford. "It was a big media debate. I just wasn't sure that there were any good data out there, so I thought I would provide insights to that."
"A lot of people could have done it," he says. "The data are out in the public domain, and anyone who has a computer can work with them. I'm sure a lot of people had a similar thought like the one I had."
The data came from the National Health and Nutrition Examination Survey from 1999 to 2006, which included information on almost 10,000 young people ages six to 17. Test results for LDL, or "bad" cholesterol were also included for 2,700 adolescents aged 12 to 17.
The AAP guidelines suggest that statins be considered for children with no risk factors other than cholesterol readings 190 or higher. Statins are also suggested for children with diabetes who have a reading of 130 or higher. For children with other risk factors such as obesity or smoking, a reading of 160 or higher suggested statin use.
After analyzing the numbers, Dr. Ford and his colleagues concluded that statin therapy would be warranted for 0.8 percent of adolescents ages 12 to 17 - a total of 200,000 in the US.
American Heart Association (AHA) guidelines call for selective screening in children with a family history of high cholesterol and early heart disease. The first line of treatment for such children should be lifestyle changes, such as healthier eating and more physical activity, the guidelines say.
The AAP agrees with that approach, says Dr. Stephen R. Daniels, chairman of pediatrics at the University of Colorado at Denver, and a member of the guideline committee.
"It's true for adults but especially true for children," Dr. Daniels says. "Clinicians should maximize their efforts on lifestyle factors before any consideration of medication."
The new report does not alter the AAP guidelines, notes Dr. Daniels, but it might provide peace of mind for some parents.
"This shows that the number of adolescents eligible for medication is relatively small," he says. The AAP does not recommend routine cholesterol screening for all children, only those at higher risk or cardiovascular problems because of family history or other warning indicators.
Always consult your child's physician for more information.
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American Academy of Family Physicians
American Heart Association
National Heart, Lung, and Blood Institute (NHLBI)
National Institute of Child Health and Human Development
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May 2009
The National Heart, Lung, and Blood Institute (NHLBI) recommends that cholesterol testing begin at age two for any child who has the following:
The NHLBI also recommends that children who have demonstrated risk factors, such as obesity, should have cholesterol and other lipids tested periodically by their physicians.
In 2008, the American Academy of Pediatrics (AAP) published updated guidelines that added more specific recommendations to those above, including testing of children older than two years whose family health history is unknown.
The AAP also recommends that physicians should consider giving cholesterol-lowering medications (statins) to children more than 8 years old who have high LDL blood levels.
A full lipid profile shows the actual levels of each type of fat in the blood: LDL, HDL, triglycerides, and others.
Consult your child's physician regarding the timeliness of this test.
Blood cholesterol is very specific to each individual, and a full lipid profile can be an important part of your child's medical history.
In general, healthy levels are as follows:
LDL - less than 130 milligrams (mg)
HDL - greater than 35 mg (less than 35 mg puts your child at higher risk for heart disease)
The NHLBI recommends the following guidelines for cholesterol levels in children and teenagers (ages 2 to 19) from families with high blood cholesterol or early heart disease:
Acceptable: Less than 170 mg Less than 110 mg
Borderline: 170 to 199 mg 110 to 129 mg
High: 200 mg or greater 130 mg or greater
Always consult your child's physician for more information.
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