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On Blood Tests for Cholesterol in Children

Last Updated: May 8, 2015

We have moved one step closer to adding statins to drinking water. The National Heart, Lung and Blood Institute recommends a cholesterol check between ages 9 and 11, with a repeated test between ages 17 and 21. The American Academy of Pediatrics endorsed the guideline. This is all children, not just those with a family history of heart disease and high cholesterol.

Before I start, though, I should mention that I am not a Pediatrician. I am an Internist, and I only treat adults. What I write below are my personal opinions, and should not be taken as medical advice. Talk to your doctor if you have specific questions about your health.

 

On Blood Tests for Cholesterol in Children

New guidelines from AAP recommend all children be screened for high cholesterol by age 11.

Why Is This Significant

Until recently, only children from families with a history of heart attacks or other cardiovascular events were being screened for high cholesterol. The problem with that approach was that a number of children with high cholesterol were missed. And because atherosclerosis begins in childhood, it seems reasonable to start screening for high cholesterol as early as possible.

The wider context of this issue is that over the last two decades, in the United States as well as in most developed countries, lifestyle related (or non-communicable) diseases have become more and more frequent among children. When I was in medical school just a couple of decades ago, I have not seen a single child with type II diabetes (after all, type II is also known as adult-onset diabetes...). Nowadays, we see type II diabetes starting during teenage years, and in some cases even before age 10.

The same trends have been noted in cholesterol values. One in five teens in the US, and more than 40 percent of obese teens, have abnormal cholesterol values. So this is not a small issue.

Is Testing Such Young Children A Good Idea?

There is still an active debate over this issue, but personally I think it is a good thing. I still encounter too many adult patients who, when I share the results of their cholesterol panel with them, have a puzzled, surprised look on their face and say something like: "Who, me? How can my cholesterol be high? I don't eat too much sugar, or bread, or rice!"

Identifying people with high cholesterol early in life, before the damage is done, and when they are still most receptive to change, is a good thing. The will become (hopefully) informed adults, educated on what it really takes to lower cholesterol through diet, and other things such as why exercise is about the only thing that would help one's HDL (good) cholesterol go up.

Another advantage of early testing is that if enough young people realize this is a problem, and they own it, maybe we will see some real change in school cafeteria menus and those vending machines would not be as ubiquitous anymore.

I Do Have One Reservation, Though…

Testing children for high cholesterol will be the easy part. What happens after the results are in is what bothers me.

According to the guidelines, the pediatrician should guide the child and family about dietary and physical activity changes that need to be implemented to lower the cholesterol. In most instances, this should be the first line of treatment. And I am in total agreement with this.

The problem is, in real life, most pediatricians in the US have to see over 20, and quite frequently, over 30 patients a day. When you have 15 minutes or less to see a patient AND write a detailed note about the visit, your ability to counsel a child and his or her family on healthy eating habits and ways to cut cholesterol is very limited.

Behavior change and education are time consuming undertakings, and most doctors won't find time for them in their busy schedules.

Teens on Statins?

So what would happen next? A lot of these children will then be put on statins, after they "failed" lifestyle change.

Now think about that for a minute: a 10 year old on a statin. That just doesn't make much sense, does it? If that's how you feel, you are not alone. Here is what an expert had to say recently on this topic:

We have no clinical trials demonstrating any benefit to treatment of elevated cholesterol levels with statins in children.

Steven E. Nissen, MD, chair of cardiovascular medicine, Cleveland Clinic.

Even if we do see studies documenting the benefits of statins in children in the future, I still see problems with their use in this age group. For one thing, girls being prescribed statins will have to stop taking them when they become sexually active and plan to have children.

According to published research, younger women who do not use oral contraception while taking statins face the risk of miscarriage when pregnant, and their offspring has a higher risk of birth defects and infant development problems if their breast-feeding mothers continue to use statins.

Boys and girls taking statins will likely develop the muscle weakness and cramps that we see in adults, too. What impact will this have on their ability and willingness and ability to exercise remains to be seen.

Recent research provide evidence that statins interfere with exercise, indicating a population of as many as 25% of users who experience " muscle fatigue, weakness, aches, and cramping due to statin therapy and potentially dismissed by patient and physician."

While we may have come one step closer to adding statins to drinking water, I'm certainly glad we are not there yet. I hope more physicians will take time to tell patients with high cholesterol, young or old, that they do have options. A plant based diet can lower the cholesterol as much as the average dose of statin does.

Dr. Gily Ionescu MS, MD.


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