Wise or Not? Doctors Sound Off on Cholesterol Tests for Kids

July 7, 2008— -- Like millions of Americans, Connor Kroll of Oak Ridge, N.J., takes the cholesterol-busting drug Lipitor. And like many others, he has reaped the medicine's benefits; in the four years he has been taking it, his dangerously high cholesterol levels have been cut nearly in half.

But Kroll stands out from the typical patient on statin drugs, like Lipitor, in one important way. He is only 16 years old.

"I'm not crazy about medications, but nothing else worked," Kroll's mother Audrey told ABC News correspondent John McKenzie. "He tried a very strict diet, and that was just not enough."

Indeed, cholesterol screening, drugs and diets have traditionally been the unwelcome chores of middle age. But for the first time, doctors with the American Academy of Pediatrics are recommending such health measures for a greater number of young children.

Under the guidelines, some 2-year-olds would receive cholesterol tests, and some children as young as 8 would take the cholesterol-lowering drugs called statins.

Reaction from doctors, both in favor of and against the move, is passionate. At stake are rising health care costs and precious time from physicians, as well as a growing obesity epidemic that is feeding America's No. 1 killer: heart disease.

"It is long past due," said Dr. Wesley Covitz, professor of cardiology and director of pediatric lipid and metabolic syndrome clinics at Wake Forest University Health Sciences in Winston Salem, N.C. "There has been a complacency among pediatric providers relevant to screening for high cholesterol," he said.

The last AAP policy in 1998 only recommended screening of children who have a family history of heart problems or rare, inherited cholesterol disorders. The new guidelines would expand cholesterol screening to all children who have body mass indexes in the 95th percentile, along with other issues, such as high blood pressure. The guidelines also lower the minimum age for cholesterol medication from 10 to 8 years old.

"I'm glad to see the pediatricians give the go-ahead to screen kids earlier and prevent these horrible problems," said Dr. Gerald Fletcher, a cardiologist and professor of medicine at the Mayo Clinic in Jacksonville, Fla. "It's nothing but a finger prick to do the screen."

But some doctors, who are equally concerned with weight and lifestyle issues, don't believe the AAP recommendations are the best way to proceed.

"This is overkill for a problem which rarely causes clinical problems before age 40, and is effectively treatable if measures are initiated in the 30 to 40 age range, or later," said Dr. Bruce Gregory Brown, professor of cardiology at the University of Washington in Seattle.

"The cost of widespread implementation of the AAP recommendations would far exceed their benefits in terms of general health effects," he said.

Brown also wonders whether statins will have a detrimental effect during puberty, when hormone levels are more sensitive to LDL cholesterol.

"While the evidence for safety of statins in the adult population is quite good, with over 20 years experience, there has not been a large experience for safety in children," Brown said. "However, the available evidence looks safe."

Whichever way doctors or parents view the new recommendations, the studies and information that prompted the policy overhaul draw concern across the board.

Disturbing Finding: Autopsies and Life Changes

Dr. Janet Silverstein, professor and chief of pediatric endocrinology at the University of Florida in Gainesville, Fla., was a member of the AAP council on nutrition that issued the new guidelines.

Since 2000, studies spanning 20 years and large autopsy studies on thousands of soldiers and children all pointed to the idea that childhood cholesterol problems can determine heart problems in middle age, Silverstein said.

"At a very young age the [autopsied children] had fatty streaks in their arteries," said Silverstein. "At the age of 8, I believe, they already had raised plaques in their arteries."

But what really alarmed Silverstein were long-term studies that showed heart disease developed over a lifetime. "We learned that even if, at the age 25, they decided to change their ways and lead the perfect life -- cardiac events were predicted by their health in adolescence," she said.

Lifestyle Still Important

Although the AAP cites such dark studies in its policy statement, neither the AAP nor the supporters of the guidelines downplay lifestyle choices. Folded into the AAP policy are diet guidelines to feed infants and toddlers reduced-fat milk.

The AAP also recommends weight management as the primary treatment for overweight children with high triglyceride levels or low levels of HDL cholesterol.

"We do know that lifestyle plays just as an important role as genetics for heart disease," says Dr. Tanya Remer Altmann, a pediatrician in Westlake Village, Calif., who worked with the national dairy council and with the AAP on the guidelines.

"It's never too early to have a healthy lifestyle," she said.