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New guidelines recommend screening children for cholesterol

Shawn Doherty  —  7/07/2008 6:34 pm

Some children as young as age 2 should now undergo routine screening for cholesterol levels during their normal checkups, according to guidelines issued today by the American Academy of Pediatrics. The AAP is also recommending aggressive use of cholesterol-lowering drugs for at-risk children as young as 8 in hopes of lowering the chance for heart problems later on in life.

"Since so much of cardiovascular disease begins in childhood, we shouldn't wait until after childhood to start screening," said Dr. Aaron Carrel, a pediatrician and director of the UW Health Pediatric Fitness Clinic who supports the new guidelines.

The AAP's guidelines replace a confusing and sometimes contradictory tangle of recommendations from various national organizations. The AAP estimated that under current guidelines, up to 60 percent of children with high cholesterol were being missed. Those numbers, experts feared, would only get worse given the growing numbers of children now considered obese in this country. The hope is that more aggressive screening will not only reduce heart problems later on in life, but help curb obesity and diabetes as well.

"More than 15 percent of children are now obese," reported Dr. Dale Schoeller, a UW professor of nutritional sciences and head of the Wisconsin Initiative for the Prevention of Obesity and Diabetes. "With obesity comes all sorts of diseases like diabetes and heart and vascular diseases that we used to think of as adult problems."

Pediatricians are now advised to give patients between the ages of 2 and 10 who have a family history of high cholesterol or heart attacks a blood test that will measure their lipid levels. If the test is fine, children should be rescreened every three to five years. If cholesterol levels come back elevated, major changes in diet and nutrition should be recommended.

According to one study cited in the report introducing the guidelines in July's Journal of Pediatrics, 13.4 percent of children in fourth grade had total cholesterol levels of more than 200 milligrams per deciliter, which is considered alarming even for adults.

Probably the most significant change, and one that might spark some disagreement given the current controversy over the increasing medication of young children, is AAP's suggestion that cholesterol drugs, or statins, be considered for children as young as age 8, if a screening shows their cholesterol levels are at or above 190 milligrams per deciliter, and if they also have a family history of heart disease. This aggressive stance replaces a 10-year-old policy that suggested children older than age 10 be treated with prescription drugs if they failed to lose weight after dieting for six to 12 months.

The first recommended treatment for helping children with elevated cholesterol levels, however, remains lifestyle changes, including improved diet and exercise habits.

Working with young children to lower their cholesterol levels and raise their fitness is something that many local pediatricians and nurses are already doing. Many of the guidelines suggested today by the AAP, for instance, are already in use by the UW Health Pediatric Clinic in Madison. The blood test that measures lipid levels currently being recommended by the AAP is just one piece of an intensive screening already in use by the clinic, which treats growing numbers of younger and younger patients every month for problems like obesity and diabetes.

Nurse Judy Hilgers says it's high time for the AAP's recommendations.

"I'm so worried about the kids out there," she said. "Our generation is going to outlive our children if we don't help them make big changes in the way they exercise and eat."

Most of her patients are obese, Hilgers reports, and a surprising number of them already have levels of cholesterol that would be considered dangerous even for adults.

"It's been hidden until now, but we're seeing an alarming number of children having cholesterol issues," Hilgers said. "If we can catch them young -- holy cow. It will be a huge help."

Shawn Doherty  —  7/07/2008 6:34 pm