The Statins for Kids Debate

It's come to this? The American Academy of Pediatrics (APA) recommends lipid-lowering statin drugs for kids as young as 8 to ward off heart disease? On the face of it, it seems ridiculous, but the proponents have good arguments, too, especially when you understand that cardiovascular disease is decades in the making, not an event triggered by a switch--like the french fry that broke the camel's back. Still, it's a difficult decision. Read the article in the LA Times. And ABC News has a Q&A with a lipid specialist, as well as a few other resources.Tara Parker-Pope covered the story in the New York Times yesterday. And if you're concerned, you should read the entire document from the APA. I can't guess how this one is going to fly. But it's another sign, as if we needed one, that many kids are eating the wrong things, too much of the right things, and not getting enough exercise. Wow.

Attention grown-ups! We're not doing our jobs!

Here is their summary. Notice the emphasis they place on diet, nutritional counseling, exercise, and lifestyle changes.

1. The population approach to a healthful diet should be recommended to all children older than 2 years according to Dietary Guidelines for Americans. This approach includes the use of low-fat dairy products. For children between 12 months and 2 years of age for whom overweight or obesity is a concern or who have a family history of obesity, dyslipidemia, or CVD, the use of reduced-fat milk would be appropriate.
   
2. The individual approach for children and adolescents at higher risk for CVD and with a high concentration of LDL includes recommended changes in diet with nutritional counseling and other lifestyle interventions such as increased physical activity.
   
3. The most current recommendation is to screen children and adolescents with a positive family history of dyslipidemia or premature (55 years of age for men and 65 years of age for women) CVD or dyslipidemia. It is also recommended that pediatric patients for whom family history is not known or those with other CVD risk factors, such as overweight (BMI 85th percentile, <95th percentile), obesity (BMI 95th percentile), hypertension (blood pressure 95th percentile), cigarette smoking, or diabetes mellitus, be screened with a fasting lipid profile.
   
4. For these children, the first screening should take place after 2 years of age but no later than 10 years of age. Screening before 2 years of age is not recommended.
   
5. A fasting lipid profile is the recommended approach to screening, because there is no currently available noninvasive method to assess atherosclerotic CVD in children. This screening should occur in the context of well-child and health maintenance visits. If values are within the reference range on initial screening, the patient should be retested in 3 to 5 years.
   
6. For pediatric patients who are overweight or obese and have a high triglyceride concentration or low HDL concentration, weight management is the primary treatment, which includes improvement of diet with nutritional counseling and increased physical activity to produce improved energy balance.
   
7. For patients 8 years and older with an LDL concentration of 190 mg/dL (or 160 mg/dL with a family history of early heart disease or 2 additional risk factors present or 130 mg/dL if diabetes mellitus is present), pharmacologic intervention should be considered. The initial goal is to lower LDL concentration to <160 mg/dL. However, targets as low as 130 mg/dL or even 110 mg/dL may be warranted when there is a strong family history of CVD, especially with other risk factors including obesity, diabetes mellitus, the metabolic syndrome, and other higher-risk situations. 

Note: CVD stands for cardiovascular disease; LDL is "bad" cholesterol.