Should all U.S. children get a cholesterol blood test?

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(AP) CHICAGO - Doctors are still debating whether all children in the United States should get screened for cholesterol months after a government-appointed panel recommended widespread screening that would lead to prescribing medicine for some kids.

Fresh criticism was published online Monday in Pediatrics by researchers at one university who say the guidelines are too aggressive and were influenced by panel members' financial ties to drugmakers.

Screen kids' cholesterol? New guidelines say yes

Eight of the 14 guidelines panel members reported industry ties and disclosed that when their advice was published in December. They contend in a rebuttal article in Pediatrics that company payments covered costs of evaluating whether the drugs are safe and effective but did not influence the recommendations.

It also is not uncommon for experts in their fields to have received some consulting fees from drug companies.

Even so, the ties pose a conflict of interest that "undermines the credibility of both the guidelines and the process through which they were produced," says the commentary by researchers at the University of California at San Francisco. The authors are Dr. Thomas Newman, a researcher and former member of a Food and Drug Administration pediatrics advisory committee, and two heart disease researchers, Drs. Mark Pletcher and Stephen Hulley.

Pletcher has received research funding from drug and device makers; the other authors said they had no relevant industry ties.

Other criticism was published earlier this year in the Journal of the American Medical Association. That critique raised concerns about putting children on cholesterol drugs called statins, noting the medicine has been linked with a rare muscle-damaging condition in adults. Those authors were heart specialist Bruce Psaty and pediatrician Frederick Rivara, both of the University of Washington in Seattle.

JAMA included additional criticism from a dissenting member of the panel that produced the kids' cholesterol guidelines, Dr. Matthew Gillman of Harvard Medical School. He recommends more narrow screening based on family history of cholesterol problems.

The guidelines are endorsed by the Academy of Pediatrics, which publishes the journal that carried the critical commentary Monday. The panel recommends that all U.S. children should get blood tests for high cholesterol as early as age 9 and that testing should begin much earlier for kids at risk of future heart disease, including those with diabetes or a family history of heart problems. Treatment should generally begin with lifestyle changes including diet and exercise, the guidelines say.

Cholesterol drugs would be recommended for some kids, but probably less than 1 percent of those tested. But the advice says those drugs, including statins, shouldn't be used at all in children younger than 10 unless they have severe problems.

The guidelines aim to help prevent and treat conditions in children that put them at risk for later heart-related problems. At least 10 percent of U.S. children have unhealthy cholesterol levels and one-third are overweight or obese.

The dispute may leave parents wondering whether to have their kids screened.

Dr. Sarah De Ferranti, an American Academy of Pediatrics spokeswoman and director of preventive cardiology at Boston Children's Hospital, said the question should be part of a conversation parents should have with their pediatrician about heart disease risks, including weight, blood pressure and lifestyle.

"Almost all of us could do better in that area," she said.

"My kids are about to turn 9 and I'm going to have them screened," said De Ferranti, who has a family history of heart disease risks.

Experts on panels that create screening and treatment recommendations for various diseases frequently have at least some financial ties to industry.

"The problem is the people who care about this issue are doing research on it and there's no way to get research done without some involvement of industry," said De Ferranti, who has done industry-funded research herself.

The critics say there's little evidence that widespread cholesterol testing and treatment in children will reduce their chances of having later heart problems. They argue that widespread testing is costly and could cause anxiety in healthy children who don't need treatment.

The National Heart, Lung and Blood Institute appointed the guidelines panel. Dr. Susan Shurin, the institute's acting director, said there are few qualified specialists who have no industry relationships, and that panel members were selected for their expertise.

"We got the best people in the country to do this," Shurin said.

Dr. Stephen Daniels, chairman of the guidelines panel, is pediatrics chief at the University of Colorado School of Medicine. He has worked as a consultant or advisory board member for Abbott Laboratories, Merck and Schering-Plough, now part of Merck, and co-authored the Pediatrics rebuttal.

Daniels said industry ties "were vetted during the discussions of the panel and I think really did not influence the debate."

The other rebuttal authors Drs. Brian McCrindle of the University of Toronto, whose industry ties include consulting or serving as advisory board member for Merck and Abbott; Peter Kwiterovich of Johns Hopkins, consulting or advisory board member for Merck and LipoScience; Patrick McBride, University of Wisconsin, who says he has had no relevant industry ties since 2007; and Rae-Ellen Kavey, University of Rochester, who listed no relevant financial ties.

[walker14u]

If there is a fire in a waste basket should water be poured on the floor until it overflows the waste basket and puts the fire out?

Economically speaking it makes sense to test those that are somewhat likely to have a problem. Grade school students must have an eye exam, ear exam, doctor exam, and be innoculated. Certainly the students should not be allowed to bring in peanut butter in any form or candy. We better make these students take courses in not offending anyone too.

Parents have rights and duties. Parents should decide if their children need medical help or treatment. Why should a parent with a very healthy child that reads well and has every indication that their site is excellent have to pay for an eye exam? Why should a parent that has observed their child be able to hear and has taken their child to a medical doctor for a medical check up have to pay for a school check up? Who is handing out all of these duties to parents? Are the ones with the must dos going to be the ones taking out their check books and paying for all of these things?

Maybe someone will come up with a study that says children that wear uniforms are healthier because they don't have to worry about dressing up to anyone. Uniform makers of America listen up. Then go to your congress person and have a law drafted that says students must wear American made uniforms. It creates jobs.

Parents have enough to do without adding one more blanket test to their kids lives. Parents know more of their childrens problems and they will do what they can to address those issues. Why does someone think they know more then parents? Why does someone think they know more then the child's doctor? The doctor is able to define at risk situations and deal with them much better then a 3rd party that looked at a page of statistics. Does anyone really believe that statistics tell the absolute truth? The first question that a person should ask is who ordered the statistics and what did they want to prove? The next question is were all underlying factors taken into account? Was the population test prejudicial?

No one should be allowed to spend the others persons time, money,or energy until there is an absolute correlation between the recommended practice and how it radically improves health.

[Jaylah54200]

So that we can start them on cholesterol lowering drugs at an earlier age? No.

Should we test their blood for lipids? Absolutely!

I have what is known as "familial hyperlipidemia." It's genetic. It means I don't process lipids in my blood properly. I didn't find out about it until I was over 30 years old.

Had I known about it earlier, I could have made some relatively small life-style changes that have made pretty drastic changes in my lipid numbers, a lot sooner.

Drugs should be the answer of LAST RESORT for elevated lipid/cholesterol numbers.

[MaxK341]

Cholesterol is an essential part of good health; especially in growing children. Besides Cholesterol is not the prime trigger of arterial disease; so this is chasing a ghost and selling drugs. Worthless guidelines from clueless authorities.

[alphaa10000]

Good points-- apparently the rationale for "cholesterol therapy" is the immense profitability of cholesterol manipulation via statins, not the prevention of cholesterol plaque formation. Dietary antioxidants and anti-inflammatories have a better effect on reducing plaque formation, since inflammation is an essential part of the plaque-forming process.

The same misdiagnosis reappears with "blood pressure control". Medical authorities understand the danger of high blood pressure, but do not universally recognize the implication of high pulse pressure-- the difference between systolic and diastolic readings. Content to concentrate on correlation of systolic numbers and disease, and lowering blood pressure, too many overlook the fact a high pulse pressure can indicate serious damage, as well.

[leah100]

The liver manufactures something like 1,000 mg of cholesterol per day, even if you consume no cholesterol at all. It's the precursor for steroid hormones like the testosterone (boys need it to grow up normally). It turns out that only oxidized cholesterol causes coronary heart disease, not normal cholesterol.

Medical cholesterol measurements say nothing at all about how much oxidized cholesterol is present.
Even worse, the drugs can be dangerous. They inhibit cholesterol production (by inhibiting the "mevalonate pathway"). But the consequences of that inhibition can be severe, insufficient enzymes, Vitamin D, CoQ10, and other substances our body needs for health, all of which have their origins in that process.

Finally, those drugs can induce a false sense of security. People who take them think they're doing something good for their health, without necessarily eliminating the processed, refined, hydrogenated, and oxidized fats that are the real source of their health risk.

[alphaa10000]

Excellent points, which remind us the problem with cholesterol is not cholesterol, per se, but rancidified (oxidized) cholesterol deposits. Such deposits occur at normal serum cholesterol levels, therefore manipulation of cholesterol intake, from any source, is not a direct or effective modification of plaque formation.

With better science, public health policy should concentrate on how to keep plaques from forming, irrespective of serum cholesterol levels. We need a model for inquiry that explains the Aleut Paradox-- Eskimo populations found heart disease rare on a native diet of seal meat and fats, with almost no green vegetables. (Vitamin C, for example, came from whale skin and blubber or seal skin, providing levels of serum C higher than the western diet average.)

Basic research suggests the reason-- Eskimos have a ratio of nearly 1:1 between omega 3 and omega 6 fats, which helps keep inflammation very low. In contrast, the traditional western diet has a very inflammatory ratio of 1:20. (http://www.naturalnews.com/022868.html)

For those tempted to follow the Eskimo dietary model, a caveat-- although Eskimos found heart disease rare, the high concentration of acid from a diet so rich in protein reduced bone density among even men, and led to osteoporosis at a relatively early age. (http://donmatesz.blogspot.com/2010/02/eskimo-osteoporosis.html)

[Nate650]

Good stuff. Thanks for posting.