New guidelines issued for lipid-lowering in kids

NEW YORK (Reuters Health) - The American Heart Association has released new guidelines for drugs that reduce high cholesterol levels, primarily statin drugs like Lipitor, in children and adolescents with high-risk cholesterol, and especially in children from families with familial hypercholesterolemia.

Familial hypercholesterolemia is a genetic disorder in which very high levels of low-density lipoprotein cholesterol (the "bad" cholesterol) develop at birth and can cause heart attacks or death at an early age.

The report, which appears in the current online issue of the medical journal Circulation, acknowledges that most children with lipid abnormalities can be successful treated solely by modifying lifestyle. The focus of the guidelines, however, is on those children who require more aggressive therapy.

The current guidelines build upon earlier recommendations set forth by the National Cholesterol Education Program (NCEP) more than 10 years ago. However, NCEP guidelines "didn't really address the use of statins," Dr. Brian McCrindle, head of the writing group, said in a statement. Since the release of those guidelines, several drug trials of children with familial hypercholesterolemia indicate the use of statins can be as safe and effective in children as in adults.

McCrindle, a professor of pediatrics at the University of Toronto, added that besides "highlighting newer evidence, this new statement addresses a greater need for recognizing young patients with multiple risk factors and how those factors could influence the decision to treat with medications or not."

Compared with the older guidelines, the new guidelines have less stringent criteria for initiating lipid-lowering drug therapy and now recommend statins as the first-line agents when therapy is needed.

Some key recommendations from the AHA statement include:

--Consider the child's weight as well as family history when deciding to obtain a fasting lipid profile.

--Look for other components of the metabolic syndrome, a cluster of risk factors for cardiovascular disease, in overweight and obese children with lipid abnormalities.

--Try lifestyle modifications first to lower cholesterol levels and if unsuccessful begin treatment with statin drug, starting at the lowest dose.

--Levels of LDL cholesterol, the "bad" type of cholesterol for which drug therapy is initiated, may be lowered in children with lipid abnormalities or other high-risk conditions.

SOURCE: Circulation, April 10, 2007.