Pediatric Cholesterol Guidelines Put More Teens on Statins: Study

By Megan Brooks

NEW YORK - About 400,000 more young people ages 17 to 21 with high LDL cholesterol would be treated with statins under pediatric guidelines as opposed to adult guidelines, a new analysis hints.

Risk factors for cardiovascular disease, including abnormal cholesterol levels, often emerge during adolescence. The 2011 National Heart, Lung, and Blood Institute Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents recommend universal screening of lipid levels for young people 17 to 21 years old, and statin treatment for those with LDL-C levels of at least 190 mg/dL without other risk factors or at least 130 or 160 mg/dL if additional risk factors are present

In contrast, the 2013 American College of Cardiology and American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults recommends statin therapy for people younger than age 40 only if their LDL-C level is at least 190 mg/dL.

"Because 17 to 21 years is a typical age for transition from pediatric to adult-centered care, these disparate approaches may lead to confusion in clinical practice," Dr. Holly Gooding, of the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital in Massachusetts and colleagues note in a report online April 6 JAMA Pediatrics.

Using National Health and Nutrition Examination Survey (NHANES) data, they determined the proportion of people 17 to 21 years old who would meet criteria for statin treatment under the two guidelines.

Among 6,338 individuals, 2.5% would qualify for statin treatment under the pediatric guidelines compared with 0.4% under the adult guidelines. Extrapolating to 20.4 million people ages 17 to 21 in the US, 483,500 individuals would be eligible for statin treatment under the pediatric guidelines compared with 78,200 under the adult guidelines, a difference of about 400,000.

The authors say the number of young people actually treated is apt to be lower owing to less than universal screening in this age group, challenges with adherence to drug regimens, and disagreement with the recommendations.

They also note that young people who met pediatric criteria had lower average LDL-C levels (167 vs 210 mg/dL) but higher proportions of other cardiovascular risk factors, including hypertension, smoking, and obesity, compared with those who met the adult guidelines.

"Many youth" have abnormal LDL cholesterol levels in the US, Dr. Gooding commented in email to Reuters Health. "Both the pediatric and adult guidelines strongly endorse a healthy lifestyle as the number one way to prevent cardiovascular disease, and clinicians should encourage abstinence from smoking, healthy diet habits, regular exercise, and maintenance of a healthy weight for these youth and for all patients."

"With regards to pharmacologic treatment of abnormal LDL cholesterol levels, I believe clinicians have some flexibility in terms of which guideline to follow. Thus, shared decision making with patients and families, considering the potential benefit and harms of treatment, is key," Dr. Gooding said.

The study had no commercial funding. Dr. Gooding serves on the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee.

SOURCE: https://bit.ly/1CcDWBL

JAMA Pediatr 2015.

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