Giving powerful cholesterol drugs to children is a drastic, even risky step, several Florida pediatricians said Monday. But doing nothing amid a national epidemic of obese children would be even riskier, they said.
"I had a child (patient) with Type 2 diabetes," said Dr. Janet Silverstein, chief of pediatric endocrinology at the University of Florida College of Medicine. "She died of a stroke when she was 18."
Silverstein is a member of the nutrition committee of the American Academy of Pediatrics, the group that issued new guidelines Monday for giving cholesterol-lowering drugs called statins to children at high risk for developing heart disease in the future.
Silverstein and several Tampa Bay pediatricians discussed the new guidelines Monday.
Under the guidelines, will more children be getting these drugs?
Only the children at greatest risk, doctors said.
"Usually if I have a child with cholesterol above 200, dietary changes will get that under control," said Tampa pediatrician Karalee Kulek-Luzey, medical director of Pediatric Health Care Alliance. "It's still the rare cases where these would be needed."
Are children really in danger of heart disease?
Not now, but long-term studies have shown that signs of heart disease start early. One study has tracked residents of a Louisiana community for more than 30 years. Autopsies of children who died in accidents there showed that some children as young as 8 had early signs of artery damage, Silverstein said.
Can't children change their diet and exercise to lower their cholesterol?
Children shouldn't get statins — which they start taking at the smallest adult dose — unless lifestyle changes have failed, doctors said. But some children have high cholesterol genetically. For others, lifestyle changes are difficult.
"It's a hard thing," said pediatric cardiologist Michael Epstein, senior vice president of medical affairs at All Children's Hospital in St. Petersburg. "Very often, you're talking about the whole family lifestyle. Everybody's got to get on board."
Have studies looked at whether it's safe and effective to give statins, such as Lipitor, Zocor and Crestor, to children?
One study of 240 children in the Netherlands found that over two years, taking a statin reduced the patients' LDL, or "bad" cholesterol, and thickening of the carotid arteries. But no long-term studies have been done.
Why would you give a drug to a child if there aren't any long-term studies?
It's a tough call, doctors admit. They say that for kids at high risk of heart disease — such as those who are obese, or have a family history — the benefits of lowering cholesterol outweigh the risks of unknown side effects.
"We're sort of making a little leap of faith to say if we control the cholesterol level, it's going to make a difference later in life," Epstein said. "But it's a logical leap of faith."
What are the potential side effects?
The most common side effects are damage to the liver and to muscles. Doctors say children would be carefully monitored for such problems.
"They would be followed very closely," said Dr. Lynn Ringenberg, chief of the general pediatrics division at the University of South Florida College of Medicine. "You can't put them on a statin and say, 'I'll see you in three years.' "
Could children have different side effects from adults? For instance, could it affect growth and development?
Not as far as anyone believes — but doctors don't know.
"We don't have any information to make us think they're going to be at greater risk," Epstein said. "But nobody knows the answers. That's why nobody should be prescribing these medications cavalierly. … We have to make sure we're not doing more harm than good."
Earlier this year, the academy said it's too risky to give over-the-counter cold medicines to young children. Is it odd that the group is willing to recommend powerful statins?
It might seem strange, but the risks and benefits are different, Kulek-Luzey said.
With cold remedies, children are using risky medicines for an illness that is gone in a few days. "But high (cholesterol) levels at young ages correlate with higher risks for (heart) disease."
What else should parents look at in the new recommendation?
The bottom line is that certain children are at risk for future heart disease, and parents should make lifestyle changes now to prevent that, Ringenberg said.
"What I really hope this does is trigger parents, physicians and everyone who takes care of children to look at diet and exercise," she said. "These are things that will keep you healthier."
Lisa Greene can be reached at firstname.lastname@example.org or (813) 226-3322.