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Not Many U.S. Kids Need Statins

Fewer than 1% with high cholesterol, study shows

MONDAY, Feb. 16 (HealthDay News) -- When Dr. Earl S. Ford read that the American Academy of Pediatrics (AAP) was recommending that children as young as 8 be given cholesterol-lowering statins, he decided to check on the numbers.

His conclusion, published in the Feb. 16 online issue of Circulation: Less than 1 percent of American children aged 12 to 17 meet the criteria for taking those drugs.

Ford is a medical officer in the U.S. Public Health Service, but his reaction to the recommendation was the same puzzlement experienced by many parents.

"I remember that after the guidelines came out, there was a lot of media stories about them," Ford said. "It was a big media debate. I just wasn't sure that there were any good data out there, so I thought I would provide insights to that."

What he did was hardly esoteric, Ford said. "A lot of people could have done it," he said. "The data are out in the public domain, and anyone who has a computer can work with them. I'm sure a lot of people had a similar thought like the one I had."

The data came from the National Health and Nutrition Examination Survey 1999 to 2006, which included information on almost 10,000 youngsters aged 6 to 17, including readings of "bad" LDL cholesterol on 2,700 adolescents aged 12 to 17.

The AAP guidelines suggest that statins be considered for children with no risk factors other than cholesterol readings 190 or higher. Statins are also suggested for a 130 or higher reading for a youngster with diabetes or a 160 reading with other risk factors, such as obesity or smoking.

Running the numbers through the computer, Ford and his colleagues concluded that statin therapy would be warranted for 0.8 percent of adolescents aged 12 to 17 -- a total of 200,000 in the United States.

Whether that is a large number "depends on what you think of less than 1 percent," Ford said.

American Heart Association guidelines call for selective screening in children with a family history of high cholesterol and early heart disease. The first line of treatment for such children should be lifestyle changes, such as healthier eating and more physical activity, the guidelines say.

The AAP agrees with that approach, said Dr. Stephen R. Daniels, chairman of pediatrics at the University of Colorado at Denver, and a member of the committee that issued the guidelines.

"It's true for adults but especially true for children," Daniels said. "Clinicians should maximize their efforts on lifestyle factors before any consideration of medication."

The new report doesn't alter the AAP guidelines, Daniels said, but it might provide peace of mind for some parents.

"This shows that the number of adolescents eligible for medication is relatively small," he said. The AAP does not recommend routine cholesterol screening for all children, only those at higher risk or cardiovascular problems because of family history or other warning indicators, Daniels added.

More information

An overall program for controlling cholesterol levels is described by the U.S. Heart, Lung, and Blood Institute.

SOURCES: Earl S. Ford, M.D., medical officer, U.S. Public Health Service, Atlanta; Stephen R. Daniels, M.D., chairman, pediatrics, University of Colorado, Denver; Feb. 16, 2009, Circulation, online

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