November 18, 2008
In an immediately controversial document, the American Academy of Pediatrics (AAP) has recommended that children as young as eight be treated with cholesterol-lowering statin drugs.
The AAP’s Committee on Nutrition released the guidelines as part of a clinical report on childhood cardiovascular health, published in the journal Pediatrics. It emphasized reducing the risk of lifetime cardiovascular disease by means of lifestyle interventions and cholesterol screening starting from a young age.
Currently, young children are only given statins if they suffer from genetic disorders such as familial hypercholesterolemia. But the report recommends that children as young as eight should be considered for treatment with cholesterol drugs if they have LDL (”bad”) cholesterol levels of 190 milligrams per decaliter or higher. It also recommends that children who have a family history or more than two other cardiovascular risk factors should be considered for treatment if their levels are 160 milligrams per decaliter or higher, as should diabetic children with LDL levels of 130 milligrams per decaliter and up.
“We know that in adults, decreasing cholesterol and giving some of those drugs decreases risk of heart disease or death,” said AAP panel member Dr Nicolas Stettler, of the Children’s Hospital of Philadelphia. “So there’s really no reason to think that would be any different in children.”
But critics have questioned this logic, saying that there is not enough data to know if statins are safe or effective in children.
The same drug often acts very differently among different age groups.
“The guidelines are based on expert opinion, and they don’t have the level of evidence to support them that I would like to see,” said Thomas B. Newman, of the University of California, San Francisco. “We don’t know at what level of cholesterol and what age the benefits of medication exceed the risks and costs. We don’t know what it means to be on these medications for decades, and we don’t know whether there’s an advantage to starting this young versus starting as an adult.”