Cholesterol: should we be testing our children?

New recommendations by the American Academy of Pediatrics (AAP) suggest that certain children should be checked for high cholesterol between the ages of 8 and 10, and then rechecked every three to five years, presumably for life.

For those with at least one parent with high cholesterol, a total cholesterol test is recommended.  For those with a family history of early heart disease (defined as a father or grandfather with heart disease before age 55 or a mother or grandmother with heart disease before age 65), a more extensive fasting lipid panel is recommended.  Other high-risk children include those with high blood pressure, diabetes or those who are overweight.

For children with significantly elevated LDL (“bad” cholesterol), the AAP suggests treatment with cholesterol drugs – possibly the same ones that dad is on.

I almost always agree with the AAP, but I was surprised by this recommendation.  While I certainly understand that they are trying to address the epidemic of food-related cardiovascular disease in this country, I think that the consequences of this new strategy simply cannot be known.

If children find out that they have high cholesterol in childhood but they don’t get treated for it, what will motivate them to start treatment as adults.  And when would they start it?  Sometimes things that you’ve had since childhood, that haven’t killed you yet, don’t seem like such a big deal.

Yet I worry more about the children who do get treated.  If children start cholesterol medicine at age 8, they may be on it for 70 years or so.   Is that really a good idea?  How can we know?  And will taking a cholesterol medicine throughout childhood have any unforeseen effects?  Again, we just can’t know.

I can see the benefit of waking up a family who has an overweight child with diabetes.  That child is at tremendously high risk of future heart disease and maybe a scary cholesterol result will compel them to turn down the sweets and turn up the veggies.  But the AAP recommendations include children who have one parent with high cholesterol or a parent/grandparent with early heart disease.  That net will catch a lot of kids.

My children fall into this high-risk group.  They are thin and athletic, but their father has high cholesterol and they lost a grandmother to heart disease in her forties.  I suppose I will have them tested, but what will I do if their cholesterol is high?  I really don’t know.  I just can’t see starting my 9 year old on a daily cholesterol pill.

I just can’t see it.

What would you do?

Dr. C.
www.insightmedicalconsultants.com

 

Topics: cardiology