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."
Cholesterol-Lowering Strategy for Kids
In their analysis, Steinberg and University of California, San Diego colleagues Christopher K. Glass, MD, PhD, and Joseph L. Witztum, MD, call for more aggressive cholesterol-lowering strategies for both children and young adults.
Current guidelines call for adults with high risk for heart attacks and other cardiac events to strive for an LDL level of 70 mg/dL or below, but the three researchers argue that 50 mg/dL or below may be a more appropriate target.
"That goal is currently attainable in many patients with the treatment regimens now available, which include statins alone or in combination with other [cholesterol-lowering] drugs," they write.
With regard to lifestyle interventions, the researchers advocate a diet low in saturated fat and cholesterol for everyone, including babies as young as 7 months.
Until last month, the AAP recommended that children between the ages of 1 and 2 drink only whole milk, but the new guidelines do not include this recommendation.
"The idea was to give pediatricians a little more flexibility," Daniels says. "Recommending whole milk should be a judgment call based on considerations like family [heart disease] history and obesity."