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Lipid-lowering therapy in children
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When the American Academy of Pediatrics released its policy statement in 2008 recommending lipid-lowering medication in children as young as age 8 years, there was an uproar in the lay media. Many mistakenly misinterpreted these guidelines as advising medication in ALL children with dyslipidemia, including those with mild or moderate dyslipidemia due to secondary factors such as poor diet and/or obesity. However, this is not what the statement advocated.
Dietary and lifestyle modifications were advised as the initial therapy, beginning as early as age 2 years. Medications are reserved only for those with severe dyslipidemia, diabetes, family history of premature cardiovascular disease and other specific high-risk conditions which failed trial of dietary and lifestyle modification.
Drug therapy was suggested in children aged 8 years or older who had no response to diet, an LDL ≥190mg/dL without risk factors, an LDL ≥160mg/dL with a family history of premature CVD or those with multiple risk factors. The guidelines recommended an initial LDL target of ≤160 mg/dL ,with a target of 130 mg/dL or even 110 mg/dL for those with multiple risk factors and/or a family history of premature CVD.
We need to remember that atherosclerosis often begins in childhood and adolescence. In some high-risk conditions, children with dyslipidemia go on to experience their first CV events in early adulthood. Although long-term data are still limited, short-term data suggest that lipid-lowering therapy in children is both safe and effective. This is particularly true for statins and bile acid sequestrants; there are less data regarding the safety and efficacy of other agents. Dietary and lifestyle modifications are, and should remain, the foundation of lipid management in children. Drug therapy is an option for high-risk pediatric patients but only after failing non-pharmacologic management first.
For more information:
- Daniels SR. Pediatrics. 2008;122:198-208.
- Zappalla FR. Endocrinol Metab Clin N Am. 2009;38:171-183.