Cholesterol Medication For Children?

The American Academy of Pediatrics (AAP) has now recommended that cholesterol-reducing statin drugs be considered for children as young as 8 years of age. But, should pills be allowed to take the place of a healthy diet and exercise?

The percentage of obesity in adults within the United States has more than doubled in the last thirty years with the that of overweight children having almost tripled. Obesity has been named as the culprit for increases in Type 2 diabetes, heart disease, hypertension, and stroke, as well as certain cancers. Now we are faced with rising cholesterol levels having become a dangerous health issue for our children, according to the Centers for Disease Control and Prevention (CDC).

A study published in the New England Journal of Medicine in 2007 suggested that children who are overweight now will increase the number of obese people to more than one-third of the population by 2020, which will lead to increases in coronary heart disease and early death as well as cause sky rocketing health care bills. Although millions of Americans take statins to successfully reduce their levels of "bad" cholesterol and decrease their risk of heart disease, there is little evidence to support that the use of these drugs will benefit young children. Although studies have shown that adolescents with elevated levels of cholesterol can benefit from statins, no long-term data is available regarding their use in the very young.

The AAP testified before a House subcommittee last year regarding children's use of their recreation time for "increasingly sedentary" activities such as playing computer games, using cellphones, sending e-mails and watching television. In addition, last year the Kaiser Family Foundation reported that 44 percent of the food advertising seen by children were commercials for junk food with no ads at all promoting fruits or vegetables.

Total cholesterol of less than 200 is optimum for adults with numbers of 200 to 239 being borderline high while numbers over 240 are considered high and create twice the risk of heart disease as numbers under 200. The acceptable total cholesterol range for children 2 to 10 years of age is less than 170. Children falling into the borderline range with total cholesterol 170 of 199 must improve their diet and increase their exercise to get their levels down. But, children who have elevated levels above 200 enter the recommended range for taking statins as a preventive measure. The AAP report can be found in the journal Pediatrics.

According to Dr. Stephen R. Daniels, chairman of the department of pediatrics at the University of Colorado School of Medicine in Denver and lead author of the new guidelines, even when proposing treatment for children with high cholesterol, "you should always start with lifestyle modifications." Begin by lowering dietary fat intake to less than 30 percent of calories, decreasing saturated fat to less than 10 percent of calories (found mostly in animal products but also in coconut and palm oils), and limit cholesterol intake to a maximum of 200 milligrams per day. According to the new guidelines, children as young as one year of age can stop drinking whole milk and replace it with reduced fat milk.

If more aggressive means are necessary, total fat can be kept below 27 percent by reducing saturated fat to 7 percent of calories, and keeping trans-fatty acids at less than 1 percent of calories with the latter two percentages following the guidelines from the American Heart Association for adults (The AHA recommends total fat below 30 percent for adults). A study of children 8 to 11 found that children who kept total fat calories to 28 percent and saturated fat to 8 percent of calories decreased their LDL cholesterol by an average of 15 points over a three-year period (The study was published in the May 10, 1995, Journal of the American Medical Association).

Another way to lower cholesterol is by eating fiber provided by whole grains, fruits and vegetables since fiber binds bile and blood cholesterol to form waste that is eliminated by the body. The guideline also lists recommended dosages for fiber supplements as being the child's age plus 5 grams a day, up to 20 grams a day at age 15. Government recommendations suggest that children 2 to 3 years of age get three ounces of grains daily and move up to seven ounces daily by 14 to 18 years of age. The new guidelines also recommend exercise in general to promote weight loss, which has been proven to lower total cholesterol in adults.

Daniels says "In most kids, you'd want to work on this for three to six months before you go to a more aggressive treatment." Then, if there is evidence of improvement cholesterol level and weight is lost at the end of this period, the lifestyle treatment could continue without adding a drug.

According to Dr. Alan Lewis in an article published in the Los Angeles Times, "If children can be introduced to these more healthful lifestyle features-healthy diet, exercise, weight control-then we have a chance that this becomes natural for them." He also noted that the children and the family share the same food at the table and the same gene pool and that it's really important to get the whole family involved. Lewis is a pediatric cardiologist and director of the lipid clinic at Children's Hospital Los Angeles.