A Growing Problem
Up to one-third of American children, from age 2 through the teenage years, have high cholesterol. American children and adolescents also have higher blood cholesterol levels and higher intakes of saturated fatty acids and cholesterol, than their counterparts in other countries, according to the American Academy of Pediatrics. And the American Heart Association reports that young children, even babies, can also have high levels of blood pressure.
Recently the American Heart Association began recommending that doctors start measuring children's blood pressure at age 3, and blood cholesterol at age 5. The American Academy of Pediatrics recommends cholesterol tests for children age 2 or older if their parents or grandparents had heart disease or vascular disease before age 55, or if their parents have cholesterol levels of 240 or higher.
"There is overwhelming evidence now that atherosclerosis, or a buildup of plaque in the arteries, starts in childhood, not when you're 50 or 60," says David J. Driscoll, MD, professor of pediatrics and director of the Division of Pediatric Cardiology at the Mayo Clinic in Rochester, Minnesota. We know this from autopsies performed on children who die of accidental deaths, he notes. Other studies on young soldiers who died in Korea and Vietnam showed that by their early 20s, many already had the beginnings of atherosclerosis. "Some of them with pretty significantly advanced disease."
We also know that there's a correlation between cholesterol and other blood fat levels in children and the degree of fatty streaking or atherosclerosis in their arteries, he said. In fact, children and adolescents with high cholesterol levels are more likely than the general population to have high levels as adults.
When to Worry
Cholesterol levels in children age 2 to 19 years should be less than 170 and LDL levels should be less than 110. Total cholesterol levels greater than 200 and/or LDL levels greater than 130 are considered high. Blood pressure levels in children vary by age, height, and weight, so talk to your doctor about where your child's should be.
"What we don't yet know is if lowering a child's cholesterol levels changes their risk later in life for developing coronary disease," says Dr. Driscoll. "Intuitively, you would think that it would, but those studies haven't been done yet." And a substantial number of children with high cholesterol levels do become adults with desirable cholesterol levels without intervention.
Nonetheless, the U.S. National Cholesterol Education Program recommends cholesterol-lowering drugs for children over age 10 whose LDL (that's the "bad" cholesterol) remains high even after they've changed their diet. Until fairly recently, the most common class of such drugs, statins, were not approved for use in children, and few large studies on their effects in children had been conducted.
But a study published in an October 2002 issue of the journal Circulation found the cholesterol-lowering drug simvastatin (Zocor) significantly reduced cholesterol levels in children with an inherited form of high cholesterol. The study, on 173 children between ages 9 and 18, also found that even after 48 weeks on the drug, there was no effect on growth or development of puberty.
Today, statins are generally considered safe to use in children and adolescents, says Dr. Driscoll, "although we use them a bit more cautiously than with adults because if you take a 55-year-old person and put them on a drug for the rest of their life and they live to be 85, that's 30 years; but with a 15-year-old, you may be talking about a very long time on that drug."
Sources: American Academy of Pediatrics Committee on Nutrition, Cholesterol in childhood. January 1998. American Heart Association, High Blood Pressure in Children recommendation American Heart Association, Cholesterol and Atherosclerosis in Children scientific position Circulation, Efficacy and safety of statin therapy in children with familial hypercholesterolemia, October 2002.
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