This week the American Academy of Pediatrics (AAP) issued a new clinical report updating the organization’s policy statement on measuring and managing high cholesterol levels in childhood. This new report mirrors most aspects of the American Heart Association’s 2007 scientific statement on Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents. 

The new statement reaffirms the previous emphasis on appropriate diet and physical activity, as well as adding pharmacologic therapy at appropriate cut-points of lipid and lipoprotein levels. It directs further attention to children between 8 and 10, suggesting that the lipid abnormalities themselves and the presence of other known cardiovascular disease risk factors should dictate therapy, eliminating consideration of the pubertal stage of the child in the decision whether to initiate pharmacologic therapy.

Specific recommendations in the two reports vary slightly, but Dr. Timothy Gardner, president of the American Heart Association, says the ultimate goal for both is the same.

“We have definitive evidence that the process of atherosclerosis – plaque building up in arteries – begins in childhood, and we know that the rate of progression is significantly increased by high cholesterol and other lipid abnormalities,” Gardner said. “The earlier we can identify these abnormalities and begin treating them appropriately, the better chance we have of reducing the risk of heart attacks, strokes, and other blood vessel problems in these individuals as they grow into adulthood. This statement will move treatment just a bit earlier.”

Both reports call for cholesterol screening in children with a family history of high cholesterol and early heart disease. In addition, children considered overweight or obese should also be screened for high cholesterol, but the first line of treatment for these children would be lifestyle changes to encourage healthier eating and increased physical activity.

When cholesterol-lowering drugs are deemed necessary, the AAP report recommends considering statin use as young as 8 years old in children who have high LDL, or “bad” cholesterol, while the previous American Heart Association statement suggested that drug therapy could be considered for those under age 10 but generally should not be started until age 10 for boys or the onset of menses for girls.

“Obviously each case will be unique and doctors need to carefully weigh all options for their young patients,” Gardner said. “Family history, gender, race, overall cholesterol levels, weight and body mass index, blood pressure, and of course smoking – these risk factors should be considered when making the decision for treatment. But the bottom line is, we know that treating or preventing heart disease early can save lives and we should look at the evidenced-based ways that can be accomplished.”
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Both the AAP report and the American Heart Association scientific statement call for continued research in the area of drug therapy for high risk lipid abnormalities in children, particularly regarding the long-term efficacy and safety, and impact on the atherosclerotic disease process.

The National Heart, Lung, and Blood Institute will be releasing evidence-based integrated cardiovascular risk reduction pediatric guidelines within the next year.

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The American Heart Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.

CONTACT:
Cathy Lewis – (214) 706-1324