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Kids & Cholesterol: Call for Early Action

Researchers Want Cholesterol-Lowering Drugs and Diet to Begin in Childhood
By
WebMD Health News
Reviewed by Louise Chang, MD

Aug. 5, 2008 -- The growing recognition that the buildup of fatty plaque in the arteries that can increase risk of heart attacks and strokes begins as early as childhood has experts calling for earlier and more aggressive treatment to reduce this risk.

Lifestyle and drug interventions aimed at lowering cholesterol beginning in early adulthood and even childhood could significantly reduce death rates from heart and vascular disease, the experts concluded in an analysis appearing in the Aug. 5 issue of the American Heart Association journal Circulation.

The current practice of prescribing cholesterol-lowering statin drugs to mostly middle-aged people who already have significant plaque buildup does not take full advantage of the potential of these drugs, longtime cholesterol researcher Daniel Steinberg, MD, PhD, of the University of California, San Diego tells WebMD.

"The research tells us that [statin] treatment as it is currently given reduces death and disability from heart disease by about 30%," he says. "Our contention is that that is a gross underestimate of the benefits we would see if we treated earlier and more aggressively."

Young Children and Statins

Last month, the American Academy of Pediatrics (AAP) created a stir by concluding that some children as young as age 8 may benefit from treatment with cholesterol-lowering statin drugs.

Newly revised AAP guidelines recommend cholesterol screening for all children who are overweight or have diabetes or high blood pressure, in addition to children with a family history of early heart disease and high cholesterol.

While the first treatment should be lifestyle changes including healthy eating and plenty of exercise, the guidelines now state that drug treatment "should be considered" even for young children with extremely high cholesterol levels, specifically:

  • LDL levels 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 heart disease risk factors.
  • LDL levels of 130 mg/dL or higher if the child has type 1 or type 2 diabetes.

"Study after study, in both adults and kids, has shown that multiple risk factors accelerate the process of plaque buildup in the arteries known as atherosclerosis," pediatrics professor Stephen R. Daniels, MD, PhD, tells WebMD.

Daniels, who is chairman of the department of pediatrics at the University of Colorado, Denver School of Medicine, was a principal author of the revised AAP guidelines. He is also a spokesman for the American Heart Association.

Daniels says only a tiny percentage of children have LDL levels high enough to make drug treatment an option, but he agrees that earlier treatment could have long-term benefits.

"Pediatricians and family physicians should be aware that atherosclerosis can begin very early in life leading to heart disease much earlier in adulthood," he says. "Early lifestyle interventions, and possibly drugs, can reduce this risk."

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200-239
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240+

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Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is optimal.

Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is near optimal.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is borderline high. If your LDL goes higher, your total cholesterol level could become Borderline High. Consider reducing the amount of foods you eat with saturated fats and increasing physical activity. If you get more exercise, your level of "good" HDL cholesterol may increase, which could also help to keep your levels of LDL and total cholesterol in check.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL. The HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is Very High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL because the HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is Borderline High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. But your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol is High, but your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol is High, but your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is Borderline High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe medication, such as statins. Following medication, dietary, and exercise instructions should result in improvements.

Your total cholesterol level is High, and your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe statins or other cholesterol-lowering medications.

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