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Local docs like cholesterol tests, not cholesterol drugs, for kids

POSTED: July 17, 2008 5:00 a.m.
SCOTT ROGERS /The Times

Dr. Joseph Gunn listens to Taylor Fry's heartbeat during the 4-year-old's checkup at The Longstreet Clinic.

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Lipitor — it’s not just for Grandpa anymore.

Cholesterol-lowering drugs called statins are already the most widely prescribed medications in the world. Now they may become even more popular as the American Academy of Pediatrics has announced new guidelines for treating high cholesterol in kids.

The organization unveiled the recommendations July 7, noting that the obesity epidemic is causing patients to develop heart disease at younger ages.

The academy advocates that children with a family history of high cholesterol or heart disease should get their first screening as early as age 2, and no later than age 10. If their cholesterol level is normal, they should be retested every three to five years.

When a child’s cholesterol tests high, medical providers should work with the family on making lifestyle changes, such as eating less fat and exercising more.

Dr. Chandra Miller, a pediatrician with the Longstreet Clinic in Gainesville, agrees that children’s cholesterol should be monitored.

"I think it’s a good idea to do the screening," she said. "It can help you detect a problem earlier, so you can get started with better diet and exercise."

But she and other pediatricians are leery of taking the next step, prescribing anti-cholesterol drugs.

"I think it will still be questionable whether or not we’re going to treat the kids with medication," Miller said, noting that no one really knows the long-term effects of giving statin drugs to children.

"Treating (with drugs) at such a young age is where I think some doctors might have an issue with it."

The academy has recommended that children ages 8 and older may need to be put on statin drugs if their cholesterol levels remain high despite conservative treatment, and if they have other risk factors, such as a family history.

Dr. Martin Siegfried, a Gainesville cardiologist, said statins are generally considered safe for children, though they are known to cause liver or muscle problems in some people.

Siegfried only treats adults, and he said for his patients, the benefits of statins usually outweigh the risks.

"In general, putting a person on a cholesterol-lowering drug reduces their risk of having heart attack or stroke or needing a bypass by about 25 percent," he said.

But that’s true for adults. No one knows whether the same results would occur in kids. And it would be difficult even to study the long-term benefits of the medication, because researchers would have to follow the patients for decades to find out how many ended up having heart attacks.

Still, said Siegfried, there’s no harm in testing children’s cholesterol levels.

"Screening for cholesterol is not necessarily a bad idea under the appropriate circumstances," he said.

And it might be worthwhile to screen all patients, because it’s not just the obese children who end up having high cholesterol.

"There is a congenital form of cholesterol disease," Siegfried said. "Screening would catch people like that, and prevent them from having a heart attack at age 10."

He said the reason doctors worry about cholesterol is that people with high levels of LDL, or "bad," cholesterol are more likely to develop atherosclerosis, or hardening of the arteries.

"If we keep the cholesterol low, we could slow the progress of atherosclerosis, which seems to be a natural process of aging," Siegfried said.

Treatment may not completely prevent heart disease, he said, but it could postpone the illness.

"By doing the right things, you can change the timing of when you develop blockages," he said.

With the increasing incidence of obesity, some people are developing plaques in their arteries far too early.

"We are seeing patients with heart disease at younger ages than we used to," Siegfried said. "The youngest person I’ve seen in the (catheterization) lab was 19."

But if children are put on statin drugs, how long should they stay on them? The Academy of Pediatrics hasn’t made that clear.

"If it’s a genetic problem, the child probably will have to be on medication for a lifetime," Siegfried said. "But if it’s caused by something that can be improved, such as obesity, they may not need medication long-term."

Miller said she probably would not prescribe statins for her patients, and would refer a child who has a cholesterol problem to a pediatric cardiologist.

But she does try to promote healthy habits to any of her patients who have complications of obesity, such as high blood pressure or diabetes. Compliance with this advice, however, depends on cooperation from the parents.

"It can be difficult for families to make lifestyle changes," she said. "Healthy foods are much more expensive than junk foods."

On the other hand, statin drugs also can be expensive, and only recently have a few of them been available in generic form.

But Siegfried said when anyone, whether a child or an adult, has a cholesterol problem, it should not be ignored.

"Cholesterol is the fourth leading cause of heart disease," he said. "The first is age, second is smoking, third is diabetes. Cholesterol is one of the factors that we can do something about."



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