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Hold the Statins

Even with the AAP’s updated guidelines for treating hyperlipidemia, few adolescents will meet criteria for pharmacologic management.

In a 2008 clinical report (JW Pediatr Adolesc Med Jul 16 2008), the AAP updated guidelines for lipid screening in children and adolescents. The new guidelines are controversial because critics believe that they will lead to increased statin use in children (JW Pediatr Adolesc Med Nov 5 2008). CDC investigators used 1999–2006 National Health and Nutrition Examination Survey data to determine the number of 12- to 17-year-old children who would potentially qualify for pharmacologic treatment based on the AAP’s current recommendations.

Fasting blood samples were obtained and low-density lipoprotein (LDL) cholesterol levels were available for 2724 of 7180 children. Only 26 adolescents (0.8%) potentially qualified for pharmacologic treatment: 11 had LDL concentrations >190 mg/dL, and 15 had LDL concentrations >160 mg/dL plus at least one risk factor (obesity, diabetes, hypertension, cigarette smoking, or a positive family history of premature cardiovascular disease).

Comment: Despite updated guidance from the AAP and the increasing prevalence of obesity in the U.S., only a small percentage of adolescents will be potentially eligible for pharmacologic intervention for hyperlipidemia. The percentage that would actually undergo treatment might be even smaller, since treatment is recommended only if abnormal values persist after diet and weight management. Although the absolute percentage of adolescents who qualify for pharmacologic treatment is low, the total number is not small. As the authors note, in a population of 25 million 12- to 17-year-old children, about 200,000 would be eligible for drug treatment.

— Alain Joffe, MD, MPH, FAAP

Published in Journal Watch Pediatrics and Adolescent Medicine March 25, 2009

Citation(s):

Ford ES et al. Concentrations of low-density lipoprotein cholesterol and total cholesterol among children and adolescents in the United States. Circulation 2009 Feb 16; [e-pub ahead of print]. (http://dx.doi.org/10.1161/CIRCULATIONAHA.108.816769)

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