Heart Association Backs Statin Use for At-Risk Kids

Those with family history of heart disease, diabetes could benefit from cholesterol drug therapy, revised guidelines now say.

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THURSDAY, March 22, 2007 (HealthDay News) -- The use of cholesterol-lowering statin drugs in youngsters should be part of updated guidelines for treating children and adolescents with high-risk lipid abnormalities, particularly high cholesterol.

That's the recommendation contained in an American Heart Association scientific statement published in the March 21 issue of the journal Circulation.

New data and increased knowledge about the beginnings of heart disease make it necessary to update the guidelines, the statement authors said.

"Guidelines drawn up by the National Cholesterol Education Program (NCEP) more than 10 years ago didn't really address the use of statins, a class of drugs that can lower cholesterol. Since that time, several drug trials in kids with familial hypercholesterolemia, a genetic predisposition to high cholesterol, have shown the use of statins had similar safety and effectiveness as in adults," Dr. Brian McCrindle, head of the statement writing group, said in a prepared statement.

"In addition to highlighting new evidence, this new statement addresses a greater need for recognizing young patients with multiple risk factors and how those factors could influence the decision to treat with medications or not," said McCrindle, a professor of pediatrics at the University of Toronto and staff cardiologist at the Hospital for Sick Children in Toronto, Canada.

The statement focuses on children with high-risk lipid abnormalities, such as familial hypercholesterolemia, diabetes, or a family history of cardiovascular disease or early heart attacks and stroke.

While other children who are overweight or obese may have elevated cholesterol levels, most of them would not meet the criteria for being prescribed cholesterol-lowering drugs. For these children, lifestyle changes would be the most appropriate treatment, McCrindle said.

Among the recommendations in the statement:

  • In addition to checking family history in overweight and obese children, doctors should do screening with a fasting lipid profile.
  • Overweight and obese children with lipid abnormalities should be screened for other aspects of metabolic syndrome, a condition characterized by a group of specific risk factors, such as excess weight, high blood pressure, elevated triglycerides, low levels of HDL "good" cholesterol and high fasting glucose levels.
  • Lifestyle changes should be recommended for most children. But, if needed, a statin (started at the lowest dose) is recommended as the first line of treatment for children who meet criteria for starting lipid-lowering drug therapy, if there are no contraindications.
  • For children with high-risk lipid abnormalities, the presence of additional risk factors or high-risk conditions may also lower the recommended levels of LDL "bad" cholesterol at which drug therapy should be started and lower the desired maintained target levels of LDL cholesterol. These high risks may include: male gender; strong family history of premature cardiovascular disease or events; presence of associated low HDL; high triglycerides; small dense LDL; presence of overweight or obesity and aspects of the metabolic syndrome; and the presence of other medical conditions associated with increased risk of atherosclerosis.

The statement also offers advice on monitoring children with lipid abnormalities as they grow, including keeping track of height, weight, body mass index, onset of puberty, and checking fasting lipoprotein profile every six to 12 months.

More information

The Nemours Foundation has more about children and cholesterol.

SOURCE: American Heart Association, news release, March 21, 2007

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