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Kids to Get Heart Disease Screening

American Academy of Pediatrics Advises Drugs for Kids Over 8 With High Cholesterol
By
WebMD Health News
Reviewed by Louise Chang, MD

new_guidelines_children_cholesterol.jpg

July 7, 2008 -- Some kids as young as 8 will need drugs to keep them from getting heart disease, according to new recommendations from the American Academy of Pediatrics.

The groundbreaking new advisory tells parents and pediatricians to screen high-risk kids for signs that they've already begun to develop heart disease. The screening test, called a fasting lipid profile, measures a child's levels of "bad" LDL cholesterol, "good" HDL cholesterol, and blood fats (triglycerides).

High-risk kids are those with a family history of high cholesterol or a family history of premature heart disease. Also included are kids who are overweight or who have high blood pressure or diabetes. Kids whose family histories are unknown should also be screened.

Treatment may be needed for kids found to be at high risk. The blood test will take a number of other risk factors into account: overweight or obesity, family history of heart disease or high cholesterol, high blood pressure, and type 1 or type 2 diabetes.

Normal and too-high cholesterol and triglyceride values for children differ from values for adults. But the AAP advisory comes with charts to help doctors understand children's results.  Doctors will tell parents which children need to be screened. They'll also help parents put the results into perspective, says pediatrician Tanya Altmann, MD, a spokeswoman for the American Academy of Pediatrics and an advisor to the National Dairy Council.

"If your child does have too-high bad cholesterol, or too-low good cholesterol, your pediatrician should talk to you,"  Altmann tells WebMD. "In some instances, a low-fat diet and exercise is all your child needs. In other cases, a medication may be needed, in conjunction with a visit to a pediatric cardiologist."

The initial treatment for kids at risk of heart disease is weight management and improved diet. But some kids as young as 8 will need to start drug treatment. These drugs include the cholesterol-lowering statin drugs. One of these drugs, Pravachol, already is FDA approved for children born into families genetically predisposed to high cholesterol.

But the new AAP guidelines say drug treatment "should be considered" only for kids who have extremely high LDL cholesterol levels:

  • LDL levels of 190 mg/dL or higher
  • LDL levels of 160 mg/dL or higher if there is a family history of heart disease or two other risk factors
  • LDL levels of 130 mg/dL or higher if the child has type 1 or type 2 diabetes

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.

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