Two very different sets of guidelines exist for when to use cholesterol lowering medications in children transitioning into adulthood. Should those aged 17 – 21 with high cholesterol be on a cholesterol-lowering drug—a statin drug? How and when to treat those younger than 40, and especially those folks 17 – 21, is not nearly as well studied as in older folks, so guidelines are based on expert recommendations from limited data in this age group.
A recent study in JAMA Pediatrics found that if guidelines for the pediatric population from the National Heart, Lung, and Blood Institute (NHLBI) were followed, 400,000 more 17-21 year olds would be on statin therapy. 400,000! Sound crazy? Let’s take a look.
2013 ACC/AHA guidelines (aka the “adult guidelines) vs 2011 NHLBI guidelines (aka the “pediatric guidelines”)
- All kids in 17-21 age group should first pursue diet and lifestyle changes to lower cholesterol levels.
- Both sets of guidelines agree that 17- to 21-year-olds who have an LDL cholesterol level above 190 should be treated with cholesterol-lowering drugs (statin drugs).
- Both agree that a younger person with an LDL level 160 – 189 with a strong family history of early heart disease (male < 55 or female < 65) should discuss treatment with their physician. Pediatric guidelines suggest these people should be treated with statin drugs.
Where the NHLHI guidelines for those aged 17 – 21 differ:
- The NHLBI/pediatric guidelines recommend screening all children between the age of 9 and 11 and again between 18 and 21 with a fasting cholesterol panel. This is rarely ever done.
- Those aged 17 – 21 with an LDL cholesterol of 160–190 plus one high-level risk factor (high blood pressure, diabetes, smoking) should be treated with a statin drug.
- Those aged individuals with LDL cholesterol of 160–190 plus two or more moderate-level risk factors (high blood pressure, obesity, low HDL cholesterol) should be treated with a cholesterol-lowering drug.
- Individuals with LDL cholesterol of 130–160 plus two high-level risk factors (high blood pressure, type II diabetes, smoking) should be treated with a cholesterol-lowering drug.
- Individuals with LDL cholesterol of 130–160 plus two or more moderate-level risk factors (obesity, low HDL cholesterol, high blood pressure) should be treated with a cholesterol lowering drug.
If we followed the NHLBI guidelines listed above, according to this recent study, almost half a million kids aged 17-21 would be on statin drugs (atorvastatin, simvastatin, Crestor). As an adult medicine doctor I can tell you: on this, we do not all agree.
What can we all agree on? Optimizing diet, exercise, and weight and promoting tobacco cessation.
Kids on statins . . . discuss.