The Kiddie Cholesterol Debate
By Alice Park
Correction Appended: July 10, 2008
Making decisions about your health is never easy, and things get even harder when the choices involve children. That's why the latest recommendation from the American Academy of Pediatrics (AAP) to widen cholesterol-testing to include kids as young as 2 is shaking up doctors and parents alike. The academy is also urging doctors to consider treating young patients from families with a history of abnormally high cholesterol levels -- a major contributor to heart disease -- with medications known as statins.
Taken together, these policies represent a desperate and perhaps even radical attempt to contain the heart disease, diabetes and other metabolic consequences of an obesity epidemic that doctors believe has spiraled out of control. "We have to start somewhere," says Dr. Jatinder Bhatia, a neonatologist at the Medical College of Georgia and member of the advisory committee that spent two years devising the guidelines. Dr. David Ludwig, a pediatrician at Children's Hospital in Boston who was not involved in making the recommendations, agrees. "We have 8-year-olds who look metabolically like an obese 60-year-old. Research predicts that this generation of children will live shorter and less healthy lives than their parents because of obesity," he says.
While the guidelines target kids with a genetic risk of abnormally high cholesterol, called hyperlipidemia, they could lower the bar for prescriptions -- not just for these children but for any overweight youngster whose cholesterol is not in check. Within hours of the AAP announcement on July 7, parents took to the blogs, expressing shock and unease over the aggressiveness of the guidelines. Statins are not without risks; in adults, in rare cases, they can cause muscle weakness and kidney problems, and there are limited data on how statins affect children.
Amid the uproar, the AAP is firmly defending the guidelines. "We think there will be more benefit than risk," says Dr. Nicolas Stettler, a committee member from Children's Hospital Philadelphia. Part of that risk could be a shift toward the quick-fix prescription and away from prevention programs involving diet and exercise to address obesity and surging cholesterol levels. Most pediatricians are wary of moving too quickly to medicate children, especially when the potential side effects are unknown. But it's certainly easier to scribble a prescription than it is to get young patients to eat better and exercise more. And then there's the possible cascade effect. "We can add statins to help overweight children," says Ludwig of Children's Hospital Boston. "But what about the next problem that comes up -- insulin resistance and fatty liver. Are we going to keep adding drug after drug? That possibility just makes me want to cry."
The original version of this article incorrectly attributed the final quote to Dr. Nicolas Stettler, a committee member from Children's Hospital Philadelphia. Those comments were in fact said by Dr. David Ludwig, of Children's Hospital Boston.