Should kids with high cholesterol be put on drugs?

Drugs vs. Diet

In this week’s issue of the JAMA, the Journal of the American Medical Association, two University of Washington doctors question the wisdom of new guidelines urging that doctors screen children and adolescents for elevated cholesterol and start them on cholesterol-lowering drugs if their levels are found to be high.

The UW researchers, Dr. Bruce Psaty and Dr. Frederick Rivara, warn that the guidelines could lead to an “epidemic” of testing and treatment of teens and adolescents when there is no strong evidence that they will benefit and a real possibility they might be harmed.

The guidelines, drawn up by an expert panel convened by the U.S. National Heart, Lung, and Blood Institute, recommend that all children be screened for high cholesterol at 9 to 11 years and again at 17 to 21 years.

Treating adults with cholesterol-lowering drugs called “statins” has been shown to reduce their risk of heart disease and stroke, Drs. Psaty and Dr. Rivara note, but there are no large, long-term studies of the use of these drugs in the young showing that treatment actually reduces their risk of heart attacks and other cardiovascular disease later in life.

Nor were the studies long enough to show whether they were safe over the long-term, they add. Among the known side effects of these drugs is a form of muscle damage called rhabdomyolysis.

In an interview accompanying the article on JAMA’s website, Dr. Rivara urges doctors to weigh the evidence behind the guidelines carefully before starting to routinely screen children for high cholesterol.

Helping young patients adopt a healthy diet and an active lifestyle, he says, would be a better course than starting children on long-term drug treatment, whose ultimate effectiveness is unknown.

To learn more:

• Read Drs. Psaty and Rivara’s article:Universal Screening and Drug Treatment of Dyslipidemia in Children and Adolescents 

• Listen to Dr. Rivara’s interview.

Category: News