Panel Backs Cholesterol Drugs for Children

MELISSA BLOCK, Host:

Medication to lower cholesterol may now be appropriate for your 8-year-old. That's according to new guidelines issued today by the American Academy of Pediatrics.

The academy's committee on nutrition also recommended cholesterol screening for children as young as 2 years old if they come from families with a history of high cholesterol or heart disease, and screening children who are simply overweight.

Some kids are genetically predisposed to high cholesterol, but the U.S. is also facing a childhood obesity epidemic.

Dr. Jatinder Bhatia is on the nutrition committee behind the new recommendations. He says America's health landscape doesn't look the way it did 10 years ago, when the committee last released its cholesterol guidelines for children.

D: What's changed is that with the increasing number of children becoming either overweight or frankly obese, the risk factor for cardiovascular disease later in life increases.

The previous screening targeted kids whose family history was positive. So that would mean you perhaps miss over half the children. So this statement has not changed the previous guidelines of targeted screening. What it says is also include overweight children even without a family history because they're also at greater risk for things like metabolic syndrome, pre-diabetes, hypertension, type 2 diabetes and so on, all of which collectively increases your risk of cardiovascular disease in adulthood.

BLOCK: And when you say overweight children, how overweight would a child have to be to merit screening, do you think?

D: Above 85 percentile. And so, after 2 years of age, if you've got risk factors or you're starting to show factors that will put risk in your way, then maybe a targeted screening or perhaps more screening than normal should be done so that healthful habits stay the same for everybody. But in addition, if you've got problems with cholesterol, then pharmacological management is being proposed for children above 8 years of age, which is a change from before.

BLOCK: And when you're looking at overweight children, the numbers here are quite striking: 30 percent of the country's children are overweight or obese.

D: Correct. It's gotten - you know, there are pockets of research that have actually shown you can take overweight children - and even with low socioeconomic status, if you give them healthful diet and exercise in appropriate proportions, they do fine. The problem is when you get back in the real world without the real world role models, it's not making a change.

And you can only do so much in schools, you can only do so much in regular programs. It's going to have to be a societal thing. And we as pediatricians have to be advocates of early screening and perhaps guidance.

BLOCK: Another change that's being recommended is that cholesterol-lowering drugs, or statins, be given at an earlier age than what had been recommended before. Why is that?

D: Because now, there are studies that show that they can reduce cholesterol and they haven't shown harm. And that's why we believe that the benefit outweighs the risk. And so far, the risk has not been proven. In adults, yeah, we have some side effects which could be bad, but they're a small number. So risk-benefit ratio is still in favor of benefit.

BLOCK: Do you expect that there would be doctors - or parents, for that matter, who would say there's not enough known about the effects of these drugs on children, and they may well not be safe?

D: Well, I'm sure. There's always a ying and yang for everything we do and that's good, so that we can debate the issue properly. So I'm sure there will be issues. Just like when we say we should start reducing one percent or reduced fat milk at 12 months of age. That's a change from before. Before, it was no child below 2 years should get low-fat or reduced-fat milks. But now, if you got a history or there are issues in the family, it may be prudent to do just that.

BLOCK: If a child comes up with a bad cholesterol reading, would you say that cholesterol-lowering drugs like statins would be a last resort, but there would be other things to be tried first?

D: Well, I think the first thing that we try - the diet and the exercise regimen, and then you want to go to statins. You wouldn't go to statins right off the bat in the first line. It should all be part of a strategy rather than a single (unintelligible) type.

BLOCK: And under these new guidelines, how many children would you expect to show high bad-cholesterol readings?

D: Well, if you look at the old data - and there's different sets of data, but I'll just quote you from one. If you look at fourth graders, for example, in one survey, actually, between 11 and 15 percent of fourth graders have cholesterols greater than 200.

BLOCK: Wow.

D: Which, even as adults, you would think is a high value. Since we know that the seed of the disease, if you will, starts early, that's why it seems more prudent to start earlier. Then we can all benefit from healthful habits from children.

BLOCK: Well, Dr. Bhatia, thanks very much for talking with us.

D: You're welcome. Thank you very much.

BLOCK: Dr. Jatinder Bhatia is a professor and chief of neonatology at the Medical College of Georgia in Augusta. Transcript provided by NPR, Copyright National Public Radio.