as 8 will need drugs to keep them from getting heart
disease, according to new recommendations from the American Academy of
The groundbreaking new advisory
tells parents and pediatricians to screen high-risk kids for signs that they've
already begun to develop heart disease. The screening test, called a fasting
lipid profile, measures a child's levels of "bad" LDL
cholesterol, "good" HDL cholesterol, and blood fats
High-risk kids are those with a
family history of high cholesterol or a family history of premature heart
disease. Also included are kids who are overweight or who have high blood
pressure or diabetes. Kids whose family histories are unknown should also
Treatment may be needed for kids
found to be at high risk. The blood test will take a number of other risk
factors into account: overweight or obesity, family history of heart disease or
high cholesterol, high blood
pressure, and type 1 or type 2
Normal and too-high cholesterol
and triglyceride values for children differ from values for adults. But the AAP
advisory comes with charts to help doctors understand children's results.
Doctors will tell parents which children need to be screened. They'll
also help parents put the results into perspective, says pediatrician Tanya
Altmann, MD, a spokeswoman for the American Academy of Pediatrics and an
advisor to the National Dairy Council.
"If your child does have
too-high bad cholesterol, or too-low good cholesterol, your pediatrician should
talk to you," Altmann tells WebMD. "In some instances, a low-fat
diet and exercise is all your child needs. In other cases, a medication may be
needed, in conjunction with a visit to a pediatric
The initial treatment for kids at
risk of heart disease is weight
management and improved diet. But some kids as young as 8 will need to
start drug treatment. These drugs include the cholesterol-lowering statin
drugs. One of these drugs, Pravachol, already is FDA approved for children born
into families genetically predisposed to high cholesterol.
But the new AAP guidelines say
drug treatment "should be considered" only for kids who have extremely
high LDL cholesterol levels:
- LDL levels of 190 mg/dL or
- LDL levels of 160 mg/dL or higher
if there is a family history of heart disease or two other risk
- LDL levels of 130 mg/dL or higher
if the child has type 1 or type 2 diabetes
For kids, these are very, very
high cholesterol levels, says Daphne T. Hsu, MD, chief of pediatric cardiology
and co-director of the pediatric heart center at New York's Montefiore Medical
"For an 8-year-old, an LDL
level of 125 to 135 is higher than 95% of children -- so 160 or 190 is really
high. Even most obese children will not be that high," Hsu tells
Hsu hopes doctors won't whittle
down the AAP recommendations and start prescribing drug treatment to children
with less extreme cholesterol levels.
are really strong drugs. You should never prescribe them unless you have a
really good reason," she says. "We don't know the effects of this
treatment as children enter their teens. Maybe these drugs block something you
need as an adolescent. It would be wrong to extrapolate this treatment
recommendation to a different population of children who are not at as high
Why screen kids for heart disease?
Very few people actually die of heart disease until they are adults. But a slew
of recent studies shows that the seeds of heart disease are sown during
childhood. Fatty streaks and artery-clogging plaque build up during childhood
and adolescence -- and the more heart-disease risk factors a child has, the
faster this fat and plaque builds up in the arteries.
Do kids with too-high cholesterol
really need to see a pediatric cardiologist?
"Well, these kids are not
going to have a stroke or heart attack as a child," Hsu says. "It takes
a village of people to help a family adopt a healthier lifestyle. It is good
for us pediatric cardiologists to explain in more detail why children need to
control their cholesterol. But lifestyle change is really difficult, and you
really need a culturally sensitive program that can offer children and families
the education that is best for them."
Here's an overview of the new AAP
- All children should eat a healthy
diet, according to the Dietary Guidelines for Americans, better known as the
new food pyramid. This approach includes the use of low-fat dairy
- Children at higher risk of heart
disease and with high cholesterol levels will have to change their diets. This
will require nutritional counseling from a dietitian as well as increased
- Screening is advised for kids
with a family history of high cholesterol or blood fats, or a family history of
premature heart disease (age 55 or younger for men, age 65 or younger for
women). Screening is also recommended for kids who are overweight (at or above
the 85th percentile), who smoke, or who have diabetes or high blood
- First screening is recommended
after age 2, but no later than age 10. Children under 2 should not be
- If the fasting lipid profile is
normal, a child should be screened again in three to five years.
- For kids who are overweight or
obese and who have a high blood-fat level or low level of "good" HDL
cholesterol, weight management is the primary treatment. This means improved
diet with nutritional counseling and increased physical exercise.
- For kids aged 8 and older with
very high cholesterol levels (or high levels with a family history of early
heart disease), drug treatment should be considered.
The new recommendations appear in
the July issue of the journal Pediatrics.
By Daniel DeNoon
Reviewed by Louise Chang
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