Statins recommended for certain 8-year-olds

Medical Tribune September 2008 P1 & 7
David Brill

Cholesterol-lowering statins should be
considered for certain children as young
as 8, the American Academy of Pediatrics
has advised.
The new guidelines, which prompted a
heated debate in parts of the international
media, have been hailed as timely by a specialist
in Singapore.
Low-fat milk is also recommended for
certain infants between 1 and 2 years old.
Rising childhood obesity rates and the
associated health risks give the recommendations
a “new urgency,” the authors wrote.
[Pediatrics 2008 Jul;122(1):198-208]
Doctors should still work aggressively
on lifestyle change, diet and weight status
before resorting to medications, said lead
author Dr. Stephen Daniels.
He said that although long-term studies
on the safety of statins in children are lacking,
the short-term data suggest a similar
profile to that seen in adults.
“While there may be things that we
don’t know yet … I think that as the data
accumulates the sense is that these agents,
when they are used appropriately, can be
effective in lowering cholesterol and are
generally safe,” said Daniels, who is pediatrician-
in-chief at The Children’s Hospital
in Denver, Colorado.
The guidelines received a mixed response
in the US, with people questioning whether
statins should be used in such young patients.
Daniels said however that only a small
minority of children would be medicated,
and most of these would be likely to have
familial hypercholesterolemia.

“I think many of them got a bit confused
about what we were really recommending
… there seemed to be this sense
among some reporters that we were recommending
statins for a large number of
children,” he said.
The guidelines state that medication
can be considered for children whose LDL
cholesterol level remains above 190 mg/
dl despite dietary therapy. For those with
other cardiovascular risk factors the recommended
cut-off point is 160 mg/dl.
Dr. Fabian Yap, head of pediatric endocrinology
at KK Women’s and Children’s
Hospital in Singapore, said that he has
already prescribed statins in patients as
young as 8, but emphasized the need for
a clear indication and close monitoring for
potential side effects.
He said that the guidelines will give
pediatricians greater flexibility in managing
obese children with lipid disorders.
“I think that the recommendation is
timely because it gives due recognition to
the fact that atherosclerosis has its roots in
childhood and that hypercholesterolemia,
which is a key modifiable risk factor for
future cardiovascular disease, ought to be
tackled as early as possible,” said Yap.
“There is unequivocal evidence that
statin therapy is the single most effective
method of lowering LDL cholesterol levels
in children and adolescents. However,
long-term safety data is obviously lacking,
which is the main reason why statin therapy
in young children ought to be undertaken
after careful risk-benefit analysis,
preferably by specialist pediatricians in a
tertiary referral center.”
Two separate meta-analyses have concluded
that statin therapy appears to be
safe for children aged 8 to 18 with familial
heterozygous hypercholesterolemia,
although only 2 years of follow-up data
is presently available. [Arterioscler Thromb
Vasc Biol 2007 Aug;27(8):1803-10; Atherosclerosis
2007 Dec;195(2):339-47]
The previous guidelines set 10 years
of age as the cut-off point for cholesterollowering
medications but limited the recommendations
to bile acid sequestrants.
[Pediatrics 1998 Jan;101:141-7]