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Giving Statins to Kids Provokes Debate
Date:7/26/2009

Cholesterol-lowering drugs may help young hearts, but long-term use raises concerns

SUNDAY, July 26 (HealthDay News) -- Whether cholesterol-lowering drugs called statins should be given to children apparently depends on who you ask.

Major health associations in the United States have recommended that obese children as young as 8 years old be treated with statins if diet and lifestyle changes don't improve their health.

But the guidelines, issued by the American Academy of Pediatrics and the American Heart Association, have sparked debate in the medical community.

Some see statin therapy as essential in combating a public health symptom of the obesity epidemic. Others believe that treating children with cholesterol-lowering drugs is a costly measure with possible long-term consequences that aren't fully understood.

"What I'm afraid of is that someone will have a modest elevation in cholesterol at age 8 without a bad family history, and an overzealous doctor will say, 'You need to be on a statin,'" said Dr. Simeon Margolis, professor of medicine and biological chemistry at Johns Hopkins University. "That means this child will be taking a statin for 60 years or more."

Obesity in adolescents has become a major health concern in the United States, with medical experts predicting potentially overwhelming levels of diabetes and heart disease as overweight children mature into adults.

Statins work by inhibiting the body's production of cholesterol while also promoting the ability to clear "bad" (LDL) cholesterol from the bloodstream.

"The consensus is that, for children with very high levels of LDL cholesterol at age 8 or older, physicians should consider statins if lifestyle and diet intervention have not been successful," said Dr. Stephen R. Daniels, chairman of pediatrics at the University of Colorado Denver School of Medicine and Children's Hospital in Denver.

He said that 8 is the youngest age for which statin treatment has been approved by the U.S. Food and Drug Administration. It's also the age when the arteries begin to suffer from aggressive buildup of plaque, a process called atherosclerosis.

"In that pre-pubescent to early pubescent stage, the process becomes more aggressive," Daniels said. "By the late teenage years or early 20s, there can be advanced plaques that are of concern. The thought is if we could intervene early, their ultimate experience with heart attacks later in life will be more favorable."

Research has found that statin therapy can have very positive long-term health benefits for some children.

"Most of the data we have now has shown statins are very effective in lowering cholesterol and as effective and safe in adolescents as they are in adults," Daniels said. "The most recent studies have shown statins can not only lower cholesterol but can improve certain measures of vascular structure and function associated with atherosclerosis in adults."

The side effects caused by statins -- elevation of liver enzymes, problems with muscle inflammation -- "can be monitored with lab tests," Daniels said.

However, if doctors stuck rigidly to the health organizations' recommendations, it appears that not many children would be given statins.

Less than 1 percent of American adolescents aged 12 to 17 years meet the American Academy of Pediatrics guidelines for receiving statin treatment, according to a review of health data published this year in the journal Circulation by Dr. Earl S. Ford, a medical officer with the U.S. Public Health Service in Atlanta. That's about 200,000 kids total.

But Margolis is concerned that many more children than that will be put on statin treatment by doctors who are not strictly following the guidelines. If that happens, families will find themselves paying potentially large amounts of money for drugs and follow-up health screenings that aren't necessary, he said.

Beyond that, there's also the cost to the child's self-image. "The child will find that they are no longer a healthy 8-year-old but are sick," Margolis said.

The overuse of statin drugs could also cause families to miss out on the chance to improve every member's health. "Rather than have the family as a whole initiate healthy lifestyle habits, they'll instead say, 'Well, we'll just take this pill,'" Margolis said.

Some doctors are also concerned about the effects that decades of statin treatment could have on the long-term health of someone who begins taking them in adolescence.

"Nobody has taken them for 60 years, so we don't know what will happen," Margolis said. However, he added that he is not as concerned about the long-term health risks as he is about the other costs to society.

More information

The U.S. Centers for Disease Control and Prevention has more on raising safe and healthy kids.



SOURCES: Simeon Margolis, M.D., Ph.D., professor, medicine and biological chemistry, Division of Endocrinology and Metabolism, Johns Hopkins University, Baltimore; Stephen R. Daniels, M.D., Ph.D., professor and chairman, Department of Pediatrics, University of Colorado Denver School of Medicine and Children's Hospital, Denver; Feb. 16, 2009, Circulation, online


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