When kids do test positive for high cholesterol, doctors can offer parents advice to eat healthier, exercise more, or potentially take cholesterol-lowering medication, although there is little to no long-term safety data regarding children on such drugs.
After bringing Kathryn to see a dietitian, Mary Leslie says she feels reassured by how well her daughter eats and has put cholesterol worries to the side. “It’s just something we know is there, and we’ll see how it goes,” she says. “I didn’t feel there was anything to do differently except remind her to exercise.”
Dr. Lee recommends that parents have a plan before their child is screened for high cholesterol. “If parents don’t want to abide by the diet, and they don’t want [their children taking] medications, then nothing about the management is going to change, and one might ask, what’s the point?”
Parents like Cassie France-Kelly, a public relations manager from New Market, Md., may end up feeling guilty when a child’s cholesterol is high, especially when they are not sure if they should—or can—dramatically change their children’s diet or activity. “I feel like I’m doing mostly the right things, and yet I have kids with high cholesterol,” she says.
Both France-Kelly and her mother have exceptionally high cholesterol, she says. Her two sons, Mason, 9, and Beckett, 4, are both on the low side of growth charts and are extremely active kids, but their total cholesterol levels are borderline high. France-Kelly says she plans to have her 2-year-old daughter tested next year, but that she would be resistant to medicating any of her children for high cholesterol.
Despite the fact that the AAP said they could be a possibility for children as young as 8 years old, cholesterol medications are not something that most parents want to consider for their kids. In reality, treating children who meet the criteria should mean that less than 1%, or about 200,000, of U.S. kids and teens need to be on cholesterol-lowering medications, according to a February 2008 study.
Statins for kids?
Placing a child on statins is different than prescribing the medications to adults, who typically wouldn’t start a drug regimen until middle age. “If you’re going to start a 10-year-old on it and say, ‘You need to take this for the rest of your life’, there’s some doubt as to whether that would be a good idea,” says Dr. Lee. “People are a bit wary of that, because [statins are] something that could potentially affect growth and development.”
Part of it may also depend on what the doctor prefers. “Some [thought] we need to be aggressive about preventing cardiovascular disease in children,” says Dr. Lee. “Others have [questioned] the long-term side effects and [whether] we should really be prescribing this in kids.”
A more aggressive treatment may be best for certain high-risk children. Autopsy studies do suggest that the first signs of heart disease—fatty “streaks” or accumulation of plaque in arteries—show up in childhood, so screening and treating sooner may prevent complications down the road.
Doctors prescribe statins in children with LDL, or bad cholesterol, levels of over 190 mg/dL with no other risk factors, or in children with LDL levels over 160 mg/dL with risk factors like diabetes, kidney failure, obesity, high blood pressure, or a family history of heart disease.
“Exactly what age to start is slightly controversial,” says Samuel S. Gidding, MD, the chief of pediatric cardiology at the Alfred I. DuPont Hospital for Children, in Wilmington, Del. “But the earlier you treat, the likelier you are to be effective with treatment.”
Statins seem to be relatively safe, says Dr. Gidding. The benefits may outweigh the risks of giving them to children at a young age, especially if cholesterol and, therefore, heart disease risk are very high—although no one really knows what happens when children take the drugs over the course of a lifetime.
“It’s not when you treat, but that you have treated the matter,” says Dr. Gidding. “You actually may want to be treated at an earlier age just so you get that protection of your blood vessels [in case] you have to go off the medication” for reasons that may come up later in life, like pregnancy.
At the very least, early screening can give parents an excuse to teach children how to manage their cholesterol levels from a young age. Doing so may prevent artery damage down the road that could in turn lead to heart disease, especially if cardiac problems run in the child’s family.
“All patients with hyperlipidemia will end up on a low cholesterol diet, and everybody should exercise aerobically, 20 to 30 minutes a day, whether they have high cholesterol or not,” says Richard Lorber, MD, a pediatrician and cardiovascular medicine specialist at the Cleveland Clinic.
However, the guidelines are also not to be taken as set-in-stone rules. “We say we treat children with risk factors and an LDL over 160 of 8 years of age, but each kid is different,” says Dr. Lorber. “Each kid is still evaluated on a personal level.”
It will be a few more years until France-Kelly’s sons are old enough to self-monitor their weight, activity, diet, and cholesterol levels. “I work full-time, so it’s not like I’m there full-time patrolling everything they eat and what they do,” she says. “You wonder if it’s something you did. You feel like you need to work a little bit harder.”
