By Dr. Janet Brill
The American Academy of Pediatrics newest guidelines for cholesterol screening and treatment in our nation’s children take an aggressive stance regarding prescription drug treatment of high cholesterol in children, with the newest recommendation dropping the age of consideration for drug treatment from “older than 10” to as young as 8.
Is it wise to prescribe prescription medication to our children to fix what used to be considered purely an “adult” medical problem? And will statin medication taken in childhood truly lower our kids’ risk of contracting early heart disease as adults?
Pediatricians are concerned not only with the epidemic of childhood obesity that has swept our nation but also with the fact that hand-in-hand with the ever-increasing prevalence of childhood obesity is the equally disturbing fact that high cholesterol as well as other diseases/disorders such as diabetes, and high blood pressure are now increasingly diagnosed in obese children; major risk factors for heart disease, the leading cause of death in this country.
Because of this dire situation among our nation’s children, we must take aggressive action to control these risk factors, in an attempt to ward off the very real probability that they will be predisposed to developing disease at an early age and potentially to premature death.
Thus, while I agree with the push to both increase detection of high cholesterol levels in children and more specifically with taking aggressive action to control this major risk factor for heart disease, I question the best approach to achieving this goal.
I am not sure about the wisdom of freely placing children as young as 8 years old on prescription statin medication to solve this problem. I think that this action should be reserved only for those children that have been aggressively treated with lifestyle change for a long period of time and have not responded favorably.
It would seem even more important for doctors to get aggressive with lifestyle change to reduce LDL cholesterol level in children, even more so than with adults—who have a lifetime of unhealthy habits under their belts.
Children are resilient and can change more easily than adults. The beauty of aggressively treating children with diet and exercise is that they will learn these habits at a young age and hopefully continue them over the long run so that they will instead be predisposed to living a long and healthy life instead of premature death.
Just as with adults, lifestyle change (namely diet and exercise) is the basis for cardiovascular disease prevention and is the foundation upon which drug therapy must be applied, should lifestyle therapy fail to fully control cholesterol.
Considering that a significant reduction in LDL cholesterol can be accomplished through a few simple lifestyle changes that are no more dangerous or expensive than eating an apple or a bowl of oatmeal and taking a daily 30 minute walk, shouldn’t this be our focus? Shouldn’t we insist on becoming aggressive with healthful and innocuous lifestyle changes in our children before we seek to medicate them to solve the problem?
Feeding our children pills without applying major lifestyle changes first and foremost will not fully protect them against future disease nor is it the wisest path to take to solve this dire threat to our children’s health and our nation’s future.
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