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Kids to Get Heart Disease Screening

American Academy of Pediatrics Advises Drugs for Kids Over 8 With High Cholesterol
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For kids, these are very, very high cholesterol levels, says Daphne T. Hsu, MD, chief of pediatric cardiology and co-director of the pediatric heart center at New York's Montefiore Medical Center.

"For an 8-year-old, an LDL level of 125 to 135 is higher than 95% of children -- so 160 or 190 is really high. Even most obese children will not be that high," Hsu tells WebMD.

Hsu hopes doctors won't whittle down the AAP recommendations and start prescribing drug treatment to children with less extreme cholesterol levels.

"Cholesterol-lowering drugs are really strong drugs. You should never prescribe them unless you have a really good reason," she says. "We don't know the effects of this treatment as children enter their teens. Maybe these drugs block something you need as an adolescent. It would be wrong to extrapolate this treatment recommendation to a different population of children who are not at as high risk."

Why screen kids for heart disease? Very few people actually die of heart disease until they are adults. But a slew of recent studies shows that the seeds of heart disease are sown during childhood. Fatty streaks and artery-clogging plaque build up during childhood and adolescence -- and the more heart-disease risk factors a child has, the faster this fat and plaque builds up in the arteries.

Do kids with too-high cholesterol really need to see a pediatric cardiologist?

"Well, these kids are not going to have a stroke or heart attack as a child," Hsu says. "It takes a village of people to help a family adopt a healthier lifestyle. It is good for us pediatric cardiologists to explain in more detail why children need to control their cholesterol. But lifestyle change is really difficult, and you really need a culturally sensitive program that can offer children and families the education that is best for them."

Here's an overview of the new AAP recommendations:

  • All children should eat a healthy diet, according to the Dietary Guidelines for Americans, better known as the new food pyramid. This approach includes the use of low-fat dairy products.
  • Children at higher risk of heart disease and with high cholesterol levels will have to change their diets. This will require nutritional counseling from a dietitian as well as increased physical activity.
  • Screening is advised for kids with a family history of high cholesterol or blood fats, or a family history of premature heart disease (age 55 or younger for men, age 65 or younger for women). Screening is also recommended for kids who are overweight (at or above the 85th percentile), who smoke, or who have diabetes or high blood pressure.
  • First screening is recommended after age 2, but no later than age 10. Children under 2 should not be screened.
  • If the fasting lipid profile is normal, a child should be screened again in three to five years.
  • For kids who are overweight or obese and who have a high blood-fat level or low level of "good" HDL cholesterol, weight management is the primary treatment. This means improved diet with nutritional counseling and increased physical exercise.
  • For kids aged 8 and older with very high cholesterol levels (or high levels with a family history of early heart disease), drug treatment should be considered.

The new recommendations appear in the July issue of the journal Pediatrics.

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