Doctors Spar Over Cholesterol Screening in Kids

MONDAY, July 23 (HealthDay News) — Researchers are debating the
merits of recent guidelines that recommend all children aged 9 through 11
be screened for high cholesterol levels, along with certain groups of
younger children and teenagers.

The guidelines were written by a panel convened by the U.S. National
Heart, Lung, and Blood Institute, endorsed by the American Academy of
Pediatrics and published in the journal Pediatrics last November.

But now doctors publishing in the current issue of Pediatrics
say the guidelines are too aggressive and not based solidly on evidence.
The paper is joined by a rebuttal from the authors of the guidelines.

The critics of the guidelines make many arguments, including that the
guidelines were based more on expert opinion than on solid evidence and
that many authors of the guidelines reported industry disclosures.

Dr. Stephen Daniels, chairman of the guidelines panel and head of
pediatrics at the University of Colorado School of Medicine in Aurora,
defended the panel Monday to the Associated Press.

Industry ties “were vetted during the discussions of the panel and I
think really did not influence the debate,” he told the AP.

Daniels, a co-author of the rebuttal, reported having worked as a
consultant or advisory board member for Abbott Laboratories, Merck and
Schering-Plough, now part of Merck. Seven other panel members also made
disclosures.

But the critics had other objections as well.

“There is expense and inconvenience to the family to have to get to the
doctor before breakfast,” said Dr. Thomas Newman, co-author of the journal
commentary article, referring to the recommendation that higher-risk 2- to
8-year-olds and 12- to 16-year-olds be screened after fasting.

There also is the issue of potentially giving lifetime medication to a
large group of people. The guidelines estimated that about 1 percent of
kids would be put on cholesterol-lowering medications if the guidelines
were followed.

“[We don’t know] how many children would need to be treated to prevent
one heart disease death,” said Newman, who is a professor of epidemiology
and biostatistics and pediatrics at the University of California, San
Francisco. “The medications would have to be extraordinarily safe, and
there haven’t been big studies with large enough numbers of children for
long enough to know.”

Newman recommends cholesterol screening start at adulthood and obese
children not be screened too early.

“Many of these kids have totally normal lipid levels and many with high
lipid levels are not obese,” he said. “You can tell if someone needs to
lose weight without having to do any blood test and recommendations for
diet and exercise really apply to everybody.”

But the issue of whom to screen and when is far from straightforward,
said one cardiologist who was involved with neither the original
guidelines nor the rebuttal.

“It’s a tough call; it’s … worthy of debate,” said Dr. Stephen Cook,
associate professor of pediatrics at the University of Rochester Medical
Center in Rochester, N.Y. Cook also said there may be an argument for
universal or near-universal screening to identify kids with familial
hypercholesterolemia, a genetic trait resulting in high cholesterol levels
unusually early in life.

Cholesterol-lowering drugs during childhood may be able to stave off
heart disease in this group of children, the rebuttal authors noted.

More information

The Nemours Foundation has more on children and cholesterol.

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