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Cholesterol drugs for some eight-year-olds recommended

Paediatrics academy urges step to fight rising tide of heart disease in the very young population

Weight loss and nutritional counselling for overweight children with too little HDL
Routine check-up of children with a family history of inherited cholesterol diseases

CHICAGO: For the first time, an influential group of doctors is recommending that some children as young as 8 be given cholesterol-fighting drugs to ward off future heart problems.

It is the strongest guidance ever given on the issue by the American Academy of Paediatrics, which released the guidelines on Monday. The academy also recommends low-fat milk for one-year-olds and wider cholesterol testing.

Stephen Daniels, of the academy’s nutrition committee, says the advice is based on mounting evidence showing that damage leading to heart disease, a leading killer, begins early in life.

It also stems from recent research showing that cholesterol-fighting drugs are generally safe for children, Dr. Daniels said.

Several of these drugs are approved for use in children and data show that increasing numbers are using them.

“If we are more aggressive about this in childhood, I think we can have an impact on what happens later in life... and avoid some of these heart attacks and strokes in adulthood,” Dr. Daniels said.

Drug treatment would generally be targeted for kids at least 8 years old who have too much LDL, the “bad” cholesterol, along with other risky conditions, including obesity and high blood pressure.

For overweight children with too little HDL, the “good” cholesterol, the first course of action should be weight loss, more physical activity and nutritional counselling, the academy says.

Paediatricians should routinely check the cholesterol of children with a family history of inherited cholesterol disease or with parents or grandparents who developed heart disease at an early age, the recommendations say.

Screening is also advised for children whose family history isn’t known and those who are overweight, obese or have other heart disease risk factors.

Screening is recommended sometime after age two but no later than age 10, at routine checkups.

The academy’s earlier advice said cholesterol drugs should only be considered in children older than 10 after they fail to lose weight. Its previous cholesterol screening recommendations also were less specific and did not include targeted ages for beginning testing.

Because obesity is a risk factor for heart disease and often is accompanied by cholesterol problems, the academy recommendations say low-fat milk is appropriate for one-year-olds “for whom overweight or obesity is a concern.”

Daniels, a paediatrician in the Denver area, agreed that could include virtually all children. But he said doctors may choose to offer the new milk advice only to one-year-olds who are already overweight or have a family history of heart problems.

The academy has long recommended against reduced-fat milk for children up to age two because saturated fats are needed for brain development.

“But now we have the obesity epidemic and people are thinking maybe this isn’t such a good idea,” said Dr. Frank Greer of the University of Wisconsin, co-author of the guidelines report, which appears in the July edition of Pediatrics, the group’s medical journal.

Very young children are increasingly getting fats from sources other than milk and Greer said the updated advice is based on recent research showing no harm from reduced-fat milk in these youngsters.

With one-third of U.S. children overweight and about 17 per cent obese, the new recommendations are important, said Dr. Jennifer Li, a Duke University children’s heart specialist. “We need to do something to stem the tide of childhood obesity.”

Dr. Li said that 15 years ago most of her patients with cholesterol problems had an inherited form of cholesterol disease not connected to obesity. “But now they’re really outnumbered” by overweight kids with cholesterol problems and high blood pressure, she said.

Elena Fuentes-Afflick, a Professor of Paediatrics at the University of California at San Francisco, praised the advice but said some parents think their kids will outgrow obesity and cholesterol problems, and might not take it seriously. “It’s hard for people to really understand” that those problems in childhood can lead to serious health consequences in adulthood, Dr. Fuentes-Afflick said.

On the Net, the American Academy of Paediatrics is at http://www.aap.org/ — AP

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