Monday, July 07, 2008

When Should Cholesterol Screening Start

At what age do you think that routine cholesterol testing should begin?
a. age 2
b. age 16
c. age 25
d. age 30

According to new recommendations by the American Academy of Pediatrics, the correct answer is A. Screening is advised to begin at age 2 and no later than age 10 for children who have a family history of high cholesterol or, or a family history of early heart disease (age 55 or younger in a male parent or grandparent, age 65 or younger for female first and second degree relatives.). Other children who should be screened regardless of family history are those who are overweight (at or above the 85th percentile), or who have risk factors such as, diabetes, or high blood pressure.

Children under age 2 should not be screened. If the fasting lipid profile is normal, a child should be screened again in three to five years. If the cholesterol level is high and the child cannot lower it by lifestyle changes in 6 to 12 months, then it is recommended to start medications such as statins to lower the cholesterol level. Normal cholesterol levels are different for children. Total cholesterol should be less than 170 and the LDL cholesterol should be less than 110.

The rationale for these guidelines is that atherosclerosis which leads to heart disease starts very early in life. With 30 percent of young Americans considered overweight or obese there is a rising concern that there will be an epidemic of heart attacks and strokes when these children reach adulthood. Although it will be controversial to start children as young as 8 on drug therapy, the Academy argues that research has shown that these medications are safe in children and that the benefit of starting the treatment earlier outweighs any potential risks.

Reference: "Lipid Screening and Cardiovascular Health in Childhood."Stephen R. Daniels, Frank R. Greer, and the Committee on Nutrition.PEDIATRICS Vol. 122 No. 1 July 2008, pp. 198-208


bread said...

Another good news for human being.

For me screening is OK even at the early age but still in doubt to use a medication using statin for lowering cholestrol level.

I think we should promote a healthy life and a proper diet to our kids rather than using synthetic drug as a medication.


Dr. Taraneh Razavi said...

bread, it is definitely true that the lifestyle modifications should be the main focus. it is the poor diet and lack of physical activity that has contributed to the obesity epidemic which has contributed to the high cholesterol and which has led to these recommendations.

Dr. Taraneh Razavi said...

joanna, the screening is suggested for children who are overweight or who have other risk factors. What is new is that in the past, the screening was only recommended for children who had a family history of heart disease, but now it is recommended regardless of the family history. The other change from previous recommendations is that rather than waiting until a minumum of age 10 for starting statins, an earlier age (8) is recommended. Everyone agrees that it would be best to lower the cholesterol by lifestyle changes.

Joanna said...

These recommendations are very controversial. Here is a nice discussion in the NY Times. They are promoting statins for people with high cholesterol. Many healthy slim active people have high cholesterol as a result of their genetics. There is little data indicating that statins help these people but the pharmaceutical companies push the drugs. Statins have very unpleasant side effects.

“What are the data that show this is helpful preventing heart attacks?” asked Dr. Darshak Sanghavi, a pediatric cardiologist and assistant professor at the University of Massachusetts Medical School. “How many heart attacks do we hope to prevent this way? There’s no data regarding that.”

Nor, Dr. Sanghavi added, are there data on the possible side effects of taking statins for 40 or 50 years.

Alison said...

Hi Joanna, I am not an expert on medication use, let alone its use in pediatrics for cholesterol lowering. I am going to defer to Dr. Razavi on this one and of course, would also support lifestlye modification as the primary intervention here. I would be most concerned with liver damage in long term use of statin drug therapy but perhaps there are individual cases where statins might be appropriate.

alisona said...

I got in touch with two endocrinologists I used to work with from UCSF - Dr. Feingold is a lead researcher and expert in the field of lipid metabolism....his response to the discussion was this....

"I cannot comment on the recommendations for children but the information regarding adults is crystal clear. There are a number of primary prevention studies in adults (i.e. patients with no clinical history of CVD) that have definitively demonstrated that statin therapy reduces events. The statement that studies show that statins do not have benefits for people who do not have heart disease is incorrect. The data that elevated cholesterol levels, particularly LDLc leads to heart disease is very very strong. Additionally, regarding side effects of statins, if one looks at the large randomized trials one sees that statins are in general very well tolerated drugs. One needs to be very careful regarding the complaints of patients on drugs. In the AFCAPs/TEXCAPs trial 2/3 of the patients on lovastatin complained of muscle aches and pains. However, 2/3 of the patients on the placebo also complained of muscle aches and pains. Many ill defined common complaints will occur in patients taking statins but whether it is due to the statin is not always clear. The only way to tell for sure is from the randomized trials and then one can compare the side effects to the placebo group and see if the side effect is actually increased in individuals taking the statin.

The issue of inflammation is more complex. There are a large number of epidemiologic studies that show that inflammation is associated with CVD. The question that needs to be answered is whether it is a marker or a cause. One can only demonstrate this by using drugs that specifically reduce inflammation without favorably affecting other factors that improve heart disease. Such studies have not yet been done but are being considered.

A good summary of the older statin trials is the following from the Lancet 2005 Oct 8; 366(9493):1267-78."

GeNiUs Kid said...

i think age at 2 still early
Just give my idea

Anonymous said...

My niece is 2 years old and her cholesterol level is 400 how can that be!