Study Says Current Guidelines May Miss Children at Risk for High Cholesterol

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One doesn't normally associate high cholesterol with children, but abnormally high levels of LDL cholesterol -- the so-called "bad" cholesterol -- in kids has become a more common problem as obesity levels have increased. Yet according to a study published in Pediatrics, the current guidelines for screening children for cholesterol misses as many as 10% of children with high cholesterol levels, including some who may benefit from cholesterol-lowering drugs. They study authors suggest all kids be screened.

It's perhaps important to note here that while cholesterol fighting drugs have been huge sellers, the long-term study is state-funded and not sponsored by any pharmaceutical or industry group. Still, even as high levels of cholesterol are known to be a major factor contributing to heart disease and stroke, the study is not without controversy.

Looking Beyond the Guidelines

Current guidelines recommend that doctors check cholesterol in children and adolescents when parents or grandparents have been diagnosed with heart disease prior to age 55, when such family history isn't known, or when a parent has total cholesterol over 240. Yet, researchers at West Virgina University found those screening guidelines miss many kids with high cholesterol levels.

They analyzed data of more than 20,000 5th grade children in West Virginia. More than 71% of the children met guidelines for cholesterol screening. Of those, 8.3% were found to have abnormal fat levels in the blood, and 1.2% of these children had such levels that warranted possible treatment with medication.

But what the study is concerned with is the children those children whose family history did not indicate a need for screening. Of those, 9.5% had abnormal levels of cholesterol, and 1.7% of these children warranted treatment with drugs.

The study authors concluded that universal screening of children for cholesterol, rather than just those with a family history, will identify more children with abnormal cholesterol levels and prevent premature cardiac events. Dr. William Neal who led the study says that statin therapy -- the most common cholesterol fighting drugs -- has been shown to be safe and effective in lowering LDL cholesterol levels in children and would curb the risk of heart problems later in life.

Nature or Nurture?

Of course, not everybody agrees. Some, like Dr. Ralph Sacco, president of the American Heart Association (AHA), suggest looking more critically at current screening guidelines, Time reports. Universal screening would be too expensive, but modifying guidelines to include children with existing risk factors for heart disease, such as obesity, high blood pressure or diabetes. If Neal is right, though, genes play more of a role in cholesterol levels than lifestyle factors do in children.

Others, as Reuters reports, are concerned with treating kids with statins. They say there is no evidence that starting children on cholesterol drugs will prevent heart disease in middle age. Further, statin treatment is not without risk; It's still controversial in children, and no long-term safety data exists. While government recommendations seem to generally agree and opt for weight management, medication should be considered for severely high cholesterol levels for kids 8 years or older.

Until updated guidelines and recommendations appear next year, parents who want to learn more can try KidsHealth.
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