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Use of statins in children is debated

September 11, 2008 12:00:00 AM PDT
The American Academy of Pediatrics recently issued a recommendation for kids at high risk for early heart disease to be put on high-powered statin drugs to lower their cholesterol. But is starting so young safe?Fourteen-year-old J.P. Silvestri is a sailor at heart, but it's that very same heart he and his family worry about.

"At age two, his LDL's were 194, and his total cholesterol was 244," said mother, Stacy Silvestri.

Normal LDL levels for a 2-year-old are less than 110 and total cholesterol -- less than 170.

J.P. is not overweight, but he has a family history of heart disease. His dad has high cholesterol and his grandfather died from it.

By age 10, J.P.'s parents put him on a statin, a cholesterol-lowering drug typically used by adults. More and more kids are on them. Doctors disagree over whether it's the best choice.

"I think it's a good thing. We now know that if we don't intervene with these children, these high risk children are really at risk for early heart disease," said pediatric endocrinologist, Dr. Janet Silverstein.

"I don't agree with the recommendation of the American Pediatric Association to do a band-aid and to fix just the cholesterol, but I recommend a total lifestyle change for the family," said ophthalmologist, Dr. Marc Rose.

There are no long-term studies on the effects of statins in children. In adults, they can cause nausea, kidney failure, muscle weakness, mental confusion, liver damage, and amnesia. J.P.'s mom feels the benefits outweigh the risks.

"If it can save him from having heart disease in his 20s, 30s, or 40s, then it's the right thing to do," said Stacy Silvestri.

J.P.'s LDL levels are now down to 116. His total cholesterol is 140. He's had no side effects, but still worries.

"If I don't eat healthy and take my medicines, I have a chance of having a heart attack," said J.P. Silvestri.

To keep your child's cholesterol levels in check, offer proteins such as salmon, beans, tofu and trout instead of red meat. Almonds are also good for lowering bad cholesterol and raising good cholesterol.

Web Extra Information:

CHOLESTEROL DRUGS FOR KIDS?

BACKGROUND:

The Centers for Disease Control and Prevention estimate that 17 percent of children and adolescents are overweight or obese. In response to this epidemic, the American Academy of Pediatrics (AAP) is now recommending cholesterol drugs for kids who are at a high risk for early heart disease. More specifically, they recommend the use of statins, drugs that lower intracellular cholesterol levels and clear bad cholesterol from circulation in children as young as eight years old. In a study released by the AAP in July, experts stated that statins are well-tolerated and result in cholesterol lowering of 20 to 50 percent below baseline. They say there have been a number of clinical trials examining the use of statins by children and adolescents and "although these studies have generally been short-term, they have shown statins to be safe and effective in lowering cholesterol concentrations."

TO MEDICATE OR NOT TO MEDICATE?

It may be true that statins are the last hope for some overweight children and their only line of defense against getting heart disease early in life; but are the risks worth it? Some parents and experts say no. Those in this school of thought are worried about long-term effects of the drugs and the risk of widespread use among children. They have even raised questions about financial ties between the AAP and drug companies.

These same opponents believe that exercise, diet and other lifestyle changes are enough to lower cholesterol levels in children. Some other risks that worry parents and experts are side effects of statins such as:

  • Muscle pain
  • Muscle atrophy
  • Confusion
  • Memory loss

On the flip side, experts like those who conducted a clinical trial published in a 2007 issue of Circulation project the benefits of statin therapy in children. Results of the study, conducted on children ages eight to 18, indicate statin treatment in children with high blood pressure delays plaque buildup in their arteries.

PREVENTION:

The same AAP recommendation for statin use in children also emphasizes the importance of screening for high cholesterol, especially in children who have a family history of obesity, high blood pressure or diabetes. Experts say screening should take place after age two, but before age 10.

 

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