Cholesterol, Drugs, and Kids

Controversial new guidelines from the American Academy of Pediatrics call for more children to get their cholesterol checked, starting as young as age 2, and for some kids to be started on statin drugs to lower their cholesterol, starting as young as age 8. I’m glad that the controversy surrounding these guidelines is starting to draw some attention to some important facts:

1) cardiovascular disease is the biggest killer in this country;
2) the habits that contribute to it are often formed during childhood; and
3) it’s not just the habits that start in childhood. The blood vessels are already changing. Fatty streaks that will one day become MI’s and strokes are already starting to form.

I agree with the importance of starting lifestyle changes now for kids with abnormal cholesterol: otherwise it’s likely to get worse over time. For this reason, I like the idea of the screening test. Knowledge is power. I prefer parents having more information about their kids’ health, not less. The results can help to identify when a child is at risk, and also help give motivation to make real changes. Lifestyle changes can be hard. Seeing your child’s test results may help shake you (and them) out of old habits. I am afraid, though, that the test results may be misused.

I’m concerned that including drugs in the general guidelines will lead too many people to rely on the drugs rather than doing the hard work necessary to control weight, change diet, and increase physical activity. For most of us, it’s changing these habits that is key to long-term health. And establishing healthy habits in the first place is key to prevention.

With stain drugs’ presence in the guidelines, pharmaceutical companies may use the opportunity to heavily advertise and promote their use in 8 year olds. While one of these drugs may be the right choice for an individual child, depending on his genes and other risk factors, recommending them broadly is another matter, even though lifestyle changes are recommended first. We don’t know yet the long term side effects of using these drugs in pre-pubertal kids. We also don’t know whether taking them during childhood would prolong life at all; it’s not even clear that for adult men who have not had heart attacks, or for any adult women, that taking them will prolong their lives. We do know that these medications can cause side effects.

Let’s use these guidelines as a wake up call to start building healthy habits of active play and healthy amounts of healthy food for all of our kids now.

Daniels SR, Greer FR, and the Committee on Nutrition. Lipid Screening and Cardiovascular Health in Childhood. Pediatrics. July 2008; 122:198-208.