Critics at odds with AAP on how to cut kids' heart disease risk

Pediatric association guidelines call for consideration of statins for children with very high cholesterol, but other physicians worry about long-term effects of such drugs.

By Victoria Stagg Elliott, AMNews staff. Aug. 11, 2008.

As data accumulate indicating that vascular disease starts decades before it becomes apparent in the form of a heart attack or stroke, physicians who treat children are increasingly looking for ways to start reducing this risk at an early age.

"We have a tremendous epidemic of obesity, and a lot of these kids now have type 2 diabetes. What is the best way to manage them?" asked Myles Abbott, MD, a board member of the American Academy of Pediatrics, although he was speaking personally.

To help answer that question, the AAP's Committee on Nutrition issued a clinical report about lipid screening and cardiovascular health during childhood in the July Pediatrics. The document emphasized lifestyle interventions at both the population and individual levels. It also advocated cholesterol screening for those at increased lifetime risk of cardiovascular disease.

The National Heart, Lung, and Blood Institute's Pediatric Cardiovascular Risk Reduction Initiative is working on its own set of guidelines due out early next year.

"I would like to see [AAP's guidelines] achieve a reasoned and rational approach to this whole area. Hopefully they will raise attention about risk factors for cardiovascular disease in general. These risk factors certainly occur in childhood and may be clustering in families," said Stephen R. Daniels, MD, PhD, the first author on the AAP guidelines. He also chairs the NHLBI's expert panel.

But starting to address the risk for a disease that most likely will not appear for decades is not without controversy. The AAP document urged that those age 8 or older with an LDL higher than 190 mg/dL be considered as possible candidates for cholesterol-lowering medication. Physicians seeing those whose levels are at 160 mg/dL with a family history or more than two other risk factors, or a level of 130 mg/dL and diabetes also should contemplate this intervention, it suggested.