Aug. 5, 2008 -- The growing recognition that the buildup
of fatty plaque in the arteries that can increase risk of
heart attacks and strokes begins as early as childhood has
experts calling for earlier and more aggressive treatment to
reduce this risk.
Lifestyle and drug interventions aimed at lowering
cholesterol beginning in early adulthood and even childhood
could significantly reduce death rates from heart and
vascular disease, the experts concluded in an analysis
appearing in the Aug. 5 issue of the American Heart
Association journal Circulation.
The current practice of prescribing cholesterol -lowering
statin drugs to mostly middle-aged people who already have
significant plaque buildup does not take full advantage of
the potential of these drugs, longtime cholesterol
researcher Daniel Steinberg, MD, PhD, of the University of
California, San Diego tells WebMD.
"The research tells us that [statin] treatment as it is
currently given reduces death and disability from heart
disease by about 30%," he says. "Our contention is that that
is a gross underestimate of the benefits we would see if we
treated earlier and more aggressively."
Young Children and Statins
Last month, the American Academy of Pediatrics (AAP)
created a stir by concluding that some children as young as
age 8 may benefit from treatment with cholesterol-lowering
statin drugs.
Newly revised AAP guidelines recommend cholesterol
screening for all children who are overweight or have
diabetes or high blood pressure , in addition to children
with a family history of early heart disease and high
cholesterol.
While the first treatment should be lifestyle changes
including healthy eating and plenty of exercise, the
guidelines now state that drug treatment "should be
considered" even for young children with extremely high
cholesterol levels , specifically:
- LDL levels 190 mg/dL or higher.
- LDL levels of 160 mg/dL or higher if there is a family
history of heart disease or two other heart disease risk
factors.
- LDL levels of 130 mg/dL or higher if the child has
type 1 or type 2 diabetes .
"Study after study, in both adults and kids, has shown
that multiple risk factors accelerate the process of plaque
buildup in the arteries known as atherosclerosis,"
pediatrics professor Stephen R. Daniels, MD, PhD, tells
WebMD.
Daniels, who is chairman of the department of pediatrics
at the University of Colorado, Denver School of Medicine,
was a principal author of the revised AAP guidelines. He is
also a spokesman for the American Heart Association.
Daniels says only a tiny percentage of children have LDL
levels high enough to make drug treatment an option, but he
agrees that earlier treatment could have long-term
benefits.
"Pediatricians and family physicians should be aware that
atherosclerosis can begin very early in life leading to
heart disease much earlier in adulthood," he says. "Early
lifestyle interventions, and possibly drugs, can reduce this
risk."
Cholesterol-Lowering Strategy for Kids
In their analysis, Steinberg and University of
California, San Diego colleagues Christopher K. Glass, MD,
PhD, and Joseph L. Witztum, MD, call for more aggressive
cholesterol-lowering strategies for both children and young
adults.
Current guidelines call for adults with high risk for
heart attacks and other cardiac events to strive for an LDL
level of 70 mg/dL or below, but the three researchers argue
that 50 mg/dL or below may be a more appropriate target.
"That goal is currently attainable in many patients with
the treatment regimens now available, which include statins
alone or in combination with other [cholesterol-lowering]
drugs," they write.
With regard to lifestyle interventions, the researchers
advocate a diet low in saturated fat and cholesterol for
everyone, including babies as young as 7 months.
Until last month, the AAP recommended that children
between the ages of 1 and 2 drink only whole milk, but the
new guidelines do not include this recommendation.
"The idea was to give pediatricians a little more
flexibility," Daniels says. "Recommending whole milk should
be a judgment call based on considerations like family
[heart disease] history and obesity."
