My apologies if the image seems dark and out of
focus. However, this perfectly exhibits my mood when
the American Academy of Pediatrics released their
cholesterol screening guidelines last week.
On a positive note, there have been several recent
studies on prevention that I am excited about.
Lastly, since alcoholic beverage makers are not
required to list calories on their labels, I think
you will find this chart
Last week, the American Academy of Pediatrics
revised their guidelines
for Lipid Screening and Cardiovascular Health in
Childhood. They have strengthened their opinion on
introducing pharmaceutical intervention. Quotes and
nothing ceases to amaze me anymore, this is
something I anticipated. Much of the country
qualified for statins when the National Cholesterol
Education Program reduced optimal cholesterol levels
in 2004. It was just a matter of time until it
trickled down to children.
- "It is difficult to develop an
evidence-based approach for the specific age at
which pharmacologic treatment should be
- "It is not known whether there is an age
at which development of the atherosclerotic
process is accelerated."
- Taking the first two comments into
consideration, the AAP still suggests the
following: "For patients 8 years and older
with an LDL concentration of 190
mg/dL (or 160
mg/dL with a family history of early heart
disease or 2
additional risk factors present or 130
mg/dL if diabetes mellitus is present),
pharmacologic intervention should be considered.
The initial goal is to lower LDL concentration
to <160 mg/dL. However, targets as low as 130
mg/dL or even 110 mg/dL may be warranted when
there is a strong family history of CVD,
especially with other risk factors including
obesity,diabetes mellitus, the metabolic
syndrome, and other higher-risk
- To their credit, the AAP does mention that
"the individual approach for children and
adolescents at higher risk for CVD and with a
high concentration of LDL includes recommended
changes in diet with nutritional counseling and
other lifestyle interventions such as increased
What is most egregious about the AAP guideline is
the lack of safety studies done on children and
statins. Statins suppress mitochondrial function in
the cell and we have no idea how that may affect
children that are still maturing. It is one thing
not to perform long-term drug studies in adults, but
when this is done to our children, it is downright
While the guidelines do mention plant sterols and
stanols as a dietary supplement therapy, there is no
mention of fish oil or other alternatives.
Is the AAP throwing in the towel in trying to help
change the eating and lifestyle habits of our
children? Or, are they using the pharmaceutical
recommendation as a scare tactic? Or, are they
simply making more Americans available to statin
therapy? I sincerely hope that the majority of
physicians who belong to this organization do not
implement these guidelines.
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