The evidence is clear that the atherosclerosis that leads to heart disease begins in childhood. Yet, physicians have been uncertain about how to treat high cholesterol levels in children because the guidelines from the National Cholesterol Education Program — now 10 years old — do not mention statins or other drugs for the treatment of children.
Now the results of several clinical trials involving children have shown that statins are safe and effective in the young. These findings have led to a new scientific statement from the American Heart Association that includes the latest guidelines for screening and treating children at risk from elevated cholesterol levels:
- Parents should have their children screened for cholesterol and other lipid abnormalities if they are overweight or obese, or if there is a family history of elevated lipid levels or premature heart disease.
- Dietary measures should be the first treatment if cholesterol levels are too high.
- Drugs should be considered in children with LDL cholesterol levels of 190 mg/dL or higher, or, if a child has a family history or two risk factors for heart disease, LDL levels of 160 mg/dL or higher.
- Statins are the drugs of choice to treat high cholesterol in children.
- Based on completed trials, the FDA has approved atorvastatin (Lipitor), lovastatin (Mevacor), pravastatin (Pravachol), and simvastatin (Zocor) for use in children.
- Statin treatment should generally be limited to boys aged 10 or older and to girls after the onset of menstruation, unless the risks are very high.
- Treatment should aim for LDL cholesterol levels less than 130 mg/dL. And since lower levels are better, the ideal goal is less than 110 mg/dL.
- Follow-up should include a fasting lipid profile, along with tests for liver enzymes and creatine kinase at four weeks after the beginning of treatment with statins, and then repeated every six months.
Doctors need to be more aggressive in their efforts to identify high-risk children. I got into the habit in my practice of asking people with elevated cholesterol levels or premature heart disease about the lipid values in their children of all ages.
I ask the parents to provide me with their children's lipid values or urge them to send their children off for a cholesterol test if this has not already been done.
