Dr. Lisa Hudgins Answers Your Questions About Cholesterol Treatment

Dr. Hudgins answered:There are four published properly conducted studies of four different statins in 706 children ages 8-18 with LDL cholesterol levels of at least 160 mg/dL treated for 1-2 years with drug or placebo. None had any serious side effects. Four children had temporary elevations in liver function tests that went away after stopping the drug. Ten had temporary elevations in muscle tests. In adults, serious problems are rare and usually occur in combination with other drugs such as Tricor. Statins should be limited to children with very high LDL cholesterol levels (>160-190 mg/dL) after optimal diet, with careful monitoring of overall health, including liver and muscle function.

Andrea from Boise, Idaho asked: I have 2 daughters that were tested for high cholesterol when they were 6 and 8. Both have high cholesterol (205 and 208). The doctor never suggested medicine and said it was from genetics. My daughters are very thin and eat great. My oldest is now 14, 5'2" and weighs 80 lbs and is an avid runner. Should I have her checked again? My husband is on Lipitor for high cholesterol.

Dr. Hudgins answered: A full lipid panel with LDL cholesterol ("bad cholesterol") and HDL cholesterol ("good cholesterol") is needed, since many children with slightly elevated total cholesterol levels have an elevated HDL cholesterol and a normal LDL cholesterol. If the complete lipid panel has not been done, it should be done after at least 3 months of better adherence to a cholesterol-lowering diet, preferably with help from a dietitian. If the LDL cholesterol is greater than 130 mg/dL, your daughters probably have a genetic form of high cholesterol, but further lowering is still possible with dietary changes. Unless the HDL is extremely low, it is unlikely that the LDL will be high enough to consider statin therapy (>160 mg/dL).

Nancy from Rochester Hills, Mich., asked: My daughter who is 15 years old has had her cholesterol checked recently and it came back at 220. Her LDL was 147 and her HDL was 48. We have started her on a strict diet of lowfat and low cholesterol food. Are her levels high enough that we should consider statins to help her lower her cholesterol levels? Last year she was checked and her levels were 211 with the LDL at 126 and her HDL at 57. At what level do you usually recommend starting drugs?

Dr. Hudgins answered: The LDL cholesterol level should be at least 160 mg/dL on several occasions after an optimal diet before considering the use of a statin. Assuming that she does not have diabetes, your daughter's levels are not high enough to warrant statin therapy. She should strive to achieve a normal body weight, follow a cholesterol-lowering diet, get ample physical activity, and not smoke. Her repeat lipid profile will probably show an LDL cholesterol level less than the goal of 130 mg/dL. Make sure her triglycerides and HDL remain normal, especially if the "low fat" diet is high in sugar/refined starch.

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