Screen kids' cholesterol? New guidelines say yes
(CBS/AP) Do kids need to get their cholesterol checked?
The National Heart, Lung and Blood Institute says yes. It's announcing Sunday new guidelines calling for children to be screened for high cholesterol before puberty, regardless of family history. The goal of the new guidelines is to prevent heart disease in later in life.
Current guidelines of major medical groups such as the American Academy of Pediatrics (AAP) recommend screening only for kids with a family history of high cholesterol or early heart disease, kids who are obese, and those with diabetes or high blood pressure.
Any call for wider screening is likely to raise concern about overdiagnosing a condition that may not cause problems for decades - if ever.
However, a West Virginia study of more than 20,000 fifth graders found that many with high cholesterol would have been missed under the current guidelines, according to Dr. Stephen Daniels, pediatrics chief at the University of Colorado School of Medicine, who led the panel that wrote the new guidelines.
Heart disease starts early in life, and "the risk factors that are important for adults are also important for children and adolescents," Daniels said.
But Daniels and other panel members said they couldn't disclose details of the advice before Sunday's presentation at an American Heart Association conference. It's the first time ever a government panel has collectively considered all major contributors to heart disease, including obesity, smoking, diabetes, high blood pressure, and high blood sugar.
One key change will be more aggressive recommendations for screening and treating high cholesterol in children. That includes "the age at which we feel we can safely use statins," said Dr. Reginald Washington, a pediatric heart specialist in Denver and member of the panel.
The AAP already advises some kids as young as 8 can safely use the cholesterol-lowering drugs, which include Lipitor and Zocor. The drugs are known to prevent heart disease and deaths in adults and are approved for use in children, but there aren't large studies that show taking statins as children reduces heart disease as adults
That is why another group of government advisers, the Preventive Services Task Force, concluded in 2007 that there's not enough known about the possible benefits and harms to recommend for or against cholesterol screening for children and teens.
But a baseline cholesterol test for kids can't hurt, said Dr. Roger Blumenthal, preventive cardiology chief at Johns Hopkins Medical Center.
"Some people will think it will lead to treatment of adolescents and people in their 20s" who don't really need it, but drug treatment should only occur if cholesterol can't be brought down with diet and lifestyle changes, he said.
Screening should happen before puberty, when cholesterol levels dip before rising again, doctors said. In children, the test does not need to involve fasting overnight and can be done from a standard blood sample or a finger-prick test.
Other parts of the new guidelines? The government will toss out terms like - "at risk for being overweight" and "overweight" - and replace them with terms that tell it like it is, such as "overweight" and "obese" for kids in the 85th and 95th percentiles, Washington said. Some doctors have been reluctant to use such frank terms in children, because of the stigma.
About a third of U.S. children and teens are obese or overweight. And government studies estimate that 10 to 13 percent of children and teens have high cholesterol - defined as a score above 200.
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