Statins For Children?!

When I read the latest headline from the American Heart Association recommending statin use in children and adolescents, my heart skipped a beat. Most drugs are not tested in children whose metabolism varies dramatically from adults’. In fact, a third of the 59 drugs tested under the Best Pharmaceuticals for Children Act have been found to work differently in children. Some were too dangerous for them while others were ineffective. So what’s the deal with suggesting that children take statins when statin use in adults has been questioned?

To my relief, the AHA Scientific Statement (pdf) printed in the journal Circulation states that statins are recommended only for children who have serious lipid abnormalities, such as familial hypercholesterolemia, or other cardiovascular conditions where keeping cholesterol at a low level is absolutely necessary. They are NOT recommending widespread use of statins in children if lifestyle modification would reduce cholesterol levels, e.g., childhood obesity.

Previous treatment recommendation for high-risk children involved mostly restricting dietary intake of fat and cholesterol along with lifestyle interventions. Drug therapy was recommended only in older children whose cholesterol levels appeared resistant to diet therapy. Clinical trials examining lipid-lowering drug therapy in children and adolescents with primary high-risk lipid abnormalities have all proven that the drugs are safe and effective. And while some have expressed concern that children might have a lower quality of life and associated anxiety over having to be on statins their entire lives, studies have shown that they’re more likely to be stressed over having a disease that leads to elevated cholesterol levels rather than the treatment itself.

Going back to diet, omega-3 fatty acids (DHA) may improve the behavior of LDL and HDL particles. Dietary fiber, soy-based protein, rapeseed or canola oil enrichment, plant stanol and sterol ester all have shown varying effectiveness in reducing bad cholesterol and increasing good cholesterol. The one supplement that does not appear to have a beneficial effect was garlic preparations.

So it appears that in a rare group of children who have underlying illnesses that cause extremely high levels of LDL cholesterol, statins may be appropriate therapy in combination with having a good diet and lifestyle. Treating children is always tricky since they are NOT mini-adults with mini-physiologies. They have different physical and mental needs that change as they grow rapidly and experience adolescence with accompanying hormonal fluctuations. As if being a child nowadays isn’t tough enough, those who live with health issues need to be even more careful. Hopefully, as greater attention is paid to children’s special health needs, all children can enjoy long, hearty lives.

NB: For more about familial hypercholesterolemia, visit MEPDED – Make Early Diagnosis to Prevent Early Death for people with inherited high cholesterol.

Tags: familial hypercholesterolemia, lipid disorders, children, kids, health, medicine, statins, illness, heart, heart disease, cardiovascular disease, cholesterol