Most children not candidates for cholesterol-lowering treatment

It turns out the benefits of cholesterol-lowering medications may only reach a minor segment of the adolescent population (age 12 to 17), according to research in the March 3 issue of Circulation: Journal of the American Heart Association.

These results come in the wake of recommendations issued last July by the American Academy of Pediatrics (AAP) in which the group of pediatricians issued guidance that children as young as 8 years old should take cholesterol-lowering drugs for prevention of heart conditions as they aged. The guidance, which sparked much ensuing criticism from pediatricians and the media, came as one response to the growing childhood obesity epidemic in the United States.

For the latest research, investigators reviewed data from a population-based survey that showed approximately 0.8% (200,000) of adolescents have an LDL level high enough to warrant drug treatment, reported Earl Ford, MD, and colleagues from the Centers for Disease Control and Prevention.

"It is a matter of opinion whether one thinks 0.8% is a small or large percentage," Ford said in a statement.Ford said the study was designed to produce numbers to know exact percentages of U.S. children who may need such treatment or who may have high cholesterol levels.

The researchers gleaned findings from The National Health and Nutrition Examination Survey (NHANES) from 1999 to 2006, which represented 2,724 adolescents age 12 to 17 whose LDL values were measured and 9,868 children age 6 to 17 who had total cholesterol values.

The average LDL concentration among adolescents 12 to 17 was 90.2 mg/dL, while total cholesterol concentration among those age 6 to 17 was 163.0 mg/dL.

Based on cut-points, according to Ford, 5.2% to 6.6% of children age 12 to 17 had elevated LDL cholesterol levels, and 9.6% to 10.7% of children age 6 to 17 had raised levels of total cholesterol.

That said, very few of the children qualified, according to AAP guidance, for cholesterol-lowering therapy, researchers noted.

In the Academy’s original guidance, it said the drugs may be used for children with:

• LDL cholesterol concentrations higher than 190 mg/dL and no other cardiovascular risk factors
• LDL cholesterol concentration higher than 160 mg/dL and other risk factors (eg, obesity, smoking, hypertension)
• LDL cholesterol concentrations of 130 mg/dL and higher and diabetes.

In the NHANES surveys that Ford and colleagues reviewed, only 26 individuals would qualify for treatment, according to AAP's criteria. Total cholesterol of more than 190 mg/dL was found in just 11 of the 26, and 15 of that same group were found to have cholesterol value of greater than 160 mg/dL, along with one risk factor.

Yet late last year, one of the principal study authors for the revised AAP guidance, Stephen R. Daniels, MD, PhD, said in a statement following issuance of AAP's recommendations, that pediatricians and family physicians "should be aware that atherosclerosis can begin very early in life leading to heart disease much earlier in adulthood. Early lifestyle interventions, and possibly drugs, can reduce this risk."

No conflicts of interest were reported with the latest study.

To view the study, click here.