Did you know that even children have been found to have atherosclerosis? This astonishing information comes from postmortem studies of healthy young American soldiers killed during the Korean and Vietnam Wars.
These findings led the National Cholesterol Education Program (NCEP) to recommend a diet low in saturated fats and cholesterol for all healthy American children over the age of 2. Such diets were not recommended for children under the age of 2 because of concerns they might interfere with the normal growth and development of these younger children.
Concerns also were raised about the use of medications to lower cholesterol levels in children. Bile acid sequestrants like cholestyramine (Questran), the first medications to be used in children, are still the only medications recommended for children by the NCEP. These medications were considered safe because they work only within the intestine.
Years ago, I remember advising a mother to use Questran to treat extremely high cholesterol levels in her 2-year-old son, whose father had had high cholesterol and had died of a heart attack when he was only 23. It soon became apparent to this mother and to me, the physician, just how difficult it is for a young child to take this medication regularly, just as it is for many adults.
Except for Welchol (available in pill form but not suitable for most children because of its large size), sequestrants need to be mixed with water or juice and taken two to three times a day. It feels like drinking sand, and constipation can be a severe and obviously troublesome side effect.
Studies have now shown that the statins can be given safely to children over the age of 10, and the FDA has approved all of the statins except rosuvastatin (Crestor) for these adolescents.
All adolescents with low-density lipoprotein (LDL) cholesterol levels greater than 130 mg/dL should be following a low-fat diet. Children whose LDL cholesterol level exceeds 160 mg/dl probably have inherited the lifelong disorder of familial hypercholesterlemia, which is caused by a defect in the receptor for LDL. Familial hypercholesterolemia greatly increases the risk of coronary artery disease.
Statin therapy is a good idea for adolescents whose LDL cholesterol remains greater than 160 mg/dL despite a healthy diet, if they have other risk factors such as diabetes or cigarette smoking, and especially if one or both parents have a history of premature coronary artery disease (before age 50 in a father or before age 65 in a mother).
