When the American Academy of Pediatrics (AAP) issued its recommendation on July 7 regarding the treatment of children with high cholesterol, it generated a strong response from the community of medical professionals and patients. The National Lipid Association (NLA), a group of healthcare professionals who specialize in cholesterol and heart disease issues, believes that the AAP has acted in the interests of patient care by raising the issue of lipid abnormalities in children.
"Healthy lifestyles with good diet and exercise at an early age are the best level of prevention from future issues of related disease," says Dr. Thomas Bersot, president of the NLA and Professor of Medicine at the University of California in San Francisco. "We enthusiastically want children to participate in healthy choices and that parents, medical practices, schools, and the community should partner whenever possible to offer good interventions and choices."
Studies show that atherosclerosis often begins in childhood and adolescence, contrary to popular belief that this is a health concern only for middle-aged and elderly persons. In some affected children, such as those with the inherited disorder, familial hypercholesterolemia (FH), or in those whose parent suffered coronary artery disease (CAD) before 50 years of age, atherosclerosis progresses more rapidly, leading to heart attacks and death from CAD in their 30s, 40s and 50s.
For the majority of children, diet and lifestyle therapy are sufficient to achieve and maintain good health through adolescence and into adulthood. Early intervention for those who are overweight or obese in childhood is of key importance and the NLA concurs with AAP that a lifelong approach to cardiovascular disease (CVD) prevention is instrumental to our efforts to reduce death and morbidity from dyslipidemia. Indeed, the most recent issue of the National Lipid Association's Journal of Clinical Lipidology ( www.lipidjournal.com ) is entirely focused on pediatric lipidology and presents an in-depth exploration of the subject. We encourage further study in this area.
Much of the controversy surrounding the AAP guidelines appears to stem from a misinterpretation regarding the use of statins and other lipid-lowering drugs. These are options for managing specific genetic hypercholesterolemias such as FH, and severe hypertriglyceridemias. There is no randomized clinical trial data of statin treatment begun in childhood with regard to adult CAD event outcomes and it is unlikely that such data will be forthcoming for decades, if ever. However, the more common dyslipidemias correlated with insulin resistance and obesity should not be routinely managed with drugs, as diet and exercise remain the best treatment choices.