A new study argues that all children nationwide should get tested for cholesterol levels. Current federal recommendations suggest doctors test children with family histories of heart disease — that means if you have a parent or grandparent who suffered a heart attack or stroke before the age of 55.
Some health experts worry that such testing could lead to inappropriate drug treatment for kids. While cholesterol-lowering medications have been proved safe and effective for adults, there are no significant studies with children. The concern is that since children would be taking these medications for the rest of their lives, long-term studies of both safety and effectiveness are needed.
Testing All Children
In West Virginia, pediatric cardiologist Dr. William Neal wanted to see what would happen if all children over the age of 10 were tested for cholesterol.
He analyzed results of more than 20,000 fifth-graders who were tested, and his findings were somewhat surprising. Neal says if testing for cholesterol had stuck to current recommendations and only children with family histories were measured, they would have missed a lot of kids with problems.
Of the 548 children they would have missed who had abnormally high cholesterol, Neal says, 98 had cholesterol levels so high that treatment with medication would be worthwhile.
No Studies On Drugs In Children
While studies have shown these cholesterol-lowering drugs are effective for adults and are mostly safe — with relatively rare side effects — there have been no studies showing the drugs' safety and effectiveness with children over the long term.
That is one major reason why Neal says the first line of defense against high cholesterol is ensuring a healthy lifestyle, including a low-saturated-fat diet and more exercise than adults. He recommends children exercise for at least one hour every day of the week.
Dr. Reginald Washington, a pediatric cardiologist with the Rocky Mountain Hospital for Children, says earlier is better when it comes to testing for cholesterol.
Starting Treatment Early
If kids are tested and diagnosed as early as age 10, then treatment, says Washington, can save lives and health care costs down the road by helping prevent hardening of the arteries — a known risk factor for heart disease.
Washington says that if someone has high cholesterol as a child, it can begin the process of arterial hardening early on. It's always better, he says, to prevent a disease process from beginning in the first place. Washington adds that research shows 70 percent of children with high cholesterol grow into adults with high cholesterol.
Harvard Medical School pediatrician Dr. Matthew Gillman agrees, but adds that testing children for potential problems later in life is a complex and potentially risky idea. When kids get tested for cholesterol, he says, they get follow-up tests and recommendations that might suggest medication and can be costly. It's a difficult balance, he says, where risks and benefits both have to be weighed.
Most doctors agree that children with genetic predispositions for high cholesterol should be tested.
Both Gillman and Washington are serving on a federal expert panel that's considering whether to recommend testing all children for cholesterol. Those recommendations are expected by the end of this year.