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New advice on kids' cholesterol tests

By Marilynn Marchione
AP Chief Medical Writer

POSTED:
LAST UPDATED: 04:14 a.m. HST, Nov 11, 2011



More children should be screened for high cholesterol before puberty, beyond those with a family history of problems, according to wide-ranging new guidelines expected from government-appointed experts who are trying to prevent heart disease later in life.

The new advice will be presented Sunday at an American Heart Association conference by some members of a panel for the National Heart, Lung and Blood Institute.

Any call for wider screening is likely to raise concern about overdiagnosing a condition that may not cause problems for decades, if ever. Yet studies suggest that half of children with high cholesterol will also have it as adults, and it's one of the best-known causes of clogged arteries that can lead to heart attacks.

Until now, major medical groups such as the American Academy of Pediatrics have advised screening only children with a family history of early heart disease or high cholesterol and those who are obese or have diabetes or high blood pressure.

However, a West Virginia study tested more than 20,000 fifth graders and found that many with high cholesterol would have been missed by the targeted screening approach used now, said Dr. Stephen Daniels, who led the panel that wrote the new guidelines.

Heart disease starts early in life, and "the risk factors that are important for adults are also important for children and adolescents," Daniels, pediatrics chief at the University of Colorado School of Medicine in Denver, told The Associated Press.

About a third of U.S. children and teens are obese or overweight. And government studies estimate that about 10 to 13 percent of children and teens have high cholesterol — defined as a score above 200.

Daniels and other members said they could not disclose details of the advice before Sunday's presentation. It's the first time a government panel has collectively considered all major contributors to heart disease including obesity, smoking, diabetes, high blood pressure and high blood sugar.

A key change will be more aggressive recommendations for cholesterol screening and treatment in children, including a change in "the age at which we feel we can safely use statins," said Dr. Reginald Washington, a pediatric heart specialist in Denver and member of the panel.

The pediatrics academy already advises that some children as young as 8 can safely use these cholesterol-lowering medicines, sold as Lipitor, Zocor and in generic form. They are known to prevent heart disease and deaths in adults and are approved for use in children. But there aren't big studies showing that using them in children will prevent heart attacks years or decades later.

That is why another group of government advisers, the Preventive Services Task Force, concluded in 2007 that there's not enough known about the possible benefits and harms to recommend for or against cholesterol screening for children and teens.

The pediatrics academy's call for selective screening came out a year later, and even that may not be catching enough children and teens who are at risk, said one of the leaders in establishing those guidelines, Dr. Frank Greer, a pediatrics professor at the University of Wisconsin in Madison.

"If you just use history of cardiovascular disease in the family, you will miss kids," he said. And with the dramatic rise in obesity, "they're at great risk," he said.

Getting a baseline cholesterol test on kids is a good idea, said Dr. Roger Blumenthal, preventive cardiology chief at Johns Hopkins Medical Center.

"Some people will think it will lead to treatment of adolescents and people in their 20s" who don't really need it, but drug treatment should only occur if cholesterol can't be brought down with diet and lifestyle changes, he said.

If screening is done, it should happen before puberty, when cholesterol levels dip before rising again, doctors explain. In children, the test does not need to involve fasting overnight and can be done from a standard blood sample or just a finger-prick test.

Other parts of the new guidelines: The government will toss out older terms — "at risk for being overweight" and "overweight" — and replace them with "overweight" and "obese" for kids in the 85th and 95th percentiles, Washington said. Some doctors have been reluctant to use such frank terms in children, because of the stigma.

The broader context for these guidelines is stepped-up efforts around the globe to target children and prevent problems later in life.

Last summer, the British government gave its first exercise advice for children under 5, urging some daily activity even for babies too young to walk. And the U.S. Institute of Medicine also recently gave diet and exercise advice for preschoolers.

AP Medical Writer Lindsey Tanner in Chicago contributed to this report.






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