Battling Heart and Stroke

Last week, the American Academy of Pediatrics (AAP) issued a revision of a policy statement from 1 January 1998 regarding lipid screening in children.

The new guidelines recommend early cholesterol screening of children and adolescents with a family history of high cholesterol or cardiovascular disease as well as children who are significantly overweight. Lipid screening should start as early as 2 years old, should be repeated 3 to 5 years later, and shouldn’t be put off beyond the 10^th year of a child’s life.

For children older than 8 years old showing high LDL cholesterol concentrations, prescription of anti-cholesterol should be considered. The AAP justifies these recommendations

“…given the current epidemic of childhood obesity with the subsequent increasing risk of type 2 diabetes mellitus, hypertension, and cardiovascular disease in older children and adults. The approach to screening children and adolescents with a fasting lipid profile remains a targeted approach.“

The drugs recommended are bile acid-binding resins, niacin or nicotinic acid, statins, and cholesterol-absorption inhibitors.

In recent years, obesity has become a problem in the US and many industrialized countries. According to the American Heart Association (AHA), 16.9% of boys and 15.6% of girls aged 6 to 11 years among non-Hispanic white Americans are overweight. Among non-Hispanic blacks, it’s 17.2% of boys and 24.8%of girls in the same age group. For Mexican Americans, it’s 25.6% of boys and 16.6% of girls.

The AAP policy statement continues:

“Overweight children belong to a special risk category of children and are in need of cholesterol screening regardless of family history or other risk factors. Thisreport reemphasizes the need for prevention of cardiovascular disease by following Dietary Guidelines for Americans and increasing physical activity and also includes a review of the pharmacologic agents and indications for treating dyslipidemia in children.“

The new recommendations of AAP closely mirror those of the American Heart Association (AHA) 2007 scientific statement on Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents, according to an AHA statement.

But a lot of people are questioning the necessity of anti-cholesterol drugs for children, especially parents and parents-to-be. A colleague from a parenting blog speculated that this might simply be another trick up the sleeve of big pharmaceutical companies to increase drug sales.

As mother to 2 young children, I can understand these parents’ concerns because I, myself, am extremely wary about feeding pills to my kids unless absolutely necessary. As an insider in the pharmaceutical industry, I am also aware that conflicts of interests in the biomedical field are common.

To be fair, the AAP recommendations also provides for non-pharmacologic preventive measures such as weight loss, nutritional counselling, and increased exercise. The use of low-fat milk and other dairy products is recommended for children as young as 1 year old. The AAP pushes close monitoring of children’s food intake and endorses the daily dietary recommendations of the American Heart Association.

We may not all agree with everything that’s in the AAP’s new guidelines but we cannot deny the fact that obesity is indeed becoming a problem among children. And that something has to be done about it.

I still believe in the power of prevention. And prevention should start at home.

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