Two recent studies published in the New England Journal of Medicine have added to a growing body of evidence linking high cholesterol, or more specifically, high levels of bad cholesterol (LDL-cholesterol), in children with heart disease in adults. While the new evidence is persuading some formerly skeptical doctors to broaden the criteria for determining which children should be screened for cholesterol, recommendations for updating the National Cholesterol Education Program (NCEP) guidelines to encourage universal childhood screening are meeting with some resistance.

Those opposed to revising the guidelines do not dispute the linkage identified in the studies, but instead argue that such an early diagnosis does not offer significant gains in terms of treatment and prevention. Some doctors have pointed to a lack of evidence supporting the value of widespread cholesterol screening for children and the prevention or mitigation of heart disease in adults. For these doctors, the assumption that available treatments, including diet, exercise, and medications, if prescribed for children with high LDL-cholesterol, will lead to healthier adult patients is not sufficient to rewrite the guidelines.

Of equal significance in the discussions surrounding the new studies is the question of drug treatment. In adults, common treatments involve medications (known as “statins”) that are effective but have significant unknowns surrounding their safety. Several doctors have voiced concerns regarding the use of such therapies on children who test for high LDL-cholesterol and so, may develop heart disease 20 or more years down the line. These doctors would prefer to use such treatments only when heart disease appears and not as a preventive measure.

Most doctors agree that teaching children about healthier lifestyles based on exercise, better eating habits, and improved diets should be the foundation of any treatment program for children who have high LDL-cholesterol levels.

Sources
“A Not-So-Minor Risk” by Elizabeth Agnvall, Washington Post, F1, December 2, 2003.
“Heart Disease: The Focus Narrows” by Linda Villarosa, NY Times, December 2, 2003, online archive (fee)