Cholesterol Screening the Kids

Jan 17, 2012

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy


Do you have your affairs in order? Are you ready for the End of Days? December 21, 2012 is less than a year away. Some really bright astronomers in ancient Mayans times made some amazingly accurate calendars. Accurate calendars are no mean feat as they take a large understanding of math and excellent observations of the sun and stars. The Mayan calendars just happen to end December 21, 2012. Does this mean the Mayan calendar makers just got tired and stopped carving the calendars into stone December 21, 2012? Is December 22, 2012 just the start of a new period of time just like Y2K was the beginning of the new Millennium? We dont really know, but several dooms-dayers interpret the end of the Mayan calendar as the end of the world.


A more recent really bright math guy was Isaac Newton. Sir Isaac basically wrote the book on physics for everyday sized objects. Newtons formulas explain how hockey pucks fly, cars crash and the moons gravity causes tides. It is even more impressive when you consider that Newton died in 1727 but it wasnt until the early twentieth century that physics started finding problems with the edges of Newtons theories. Newtons classical mechanics dont work on really small things like sub-atomic particles and really big things like clusters of galaxies. Newton was so bright he even invented a branch of math to help him solve his physics problems. You might have heard of it. Newton invented calculus.


As bright as Newton was, he had a whacky side too. He was very religious and wrote quite a bit about the occult. He wrote extensively about his interpretation of the Book of Revelations. He liked writing and thinking about the Apocalypse. I think of him writing the 1700s version of the Left Behind series. He had a prediction for the end of the world as well. Newton said the world wont end before 2060. So you 2012ers are way off.


The Mayan calendar makers were very bright. Newton is one of my heroes for his theories classical physics and calculus. But even these brilliant folks were way out to lunch on their predictions of the end of the world. I think the very bright folks at the American Academy of Pediatrics (AAP) might out to lunch about their plan to do cholesterol screening in children.


There is a childhood obesity problem in North America. Our kids are fatter, less physically active and arguably less healthy than at any point in the recent past. Obesity, high blood pressure, diabetes, smoking and abnormal cholesterol values are all risk factors for heart attack and stroke. With the recent increase in childhood obesity, researchers have noticed an increase in children with abnormal cholesterol levels. We know that abnormal cholesterol levels like high LDL or bad cholesterol, low HDL or good cholesterol and high triglycerides can be contributing factors to fatty streaks in the blood vessels of teenagers. These fatty streaks can grow into plaques or partial blockages of blood vessels as the person ages. If a plaque ruptures in the wrong place, that can be a heart attack or stroke.


Because there are more kids with cholesterol problems the AAP is recommending all children between the ages of 9 and 11 should have a cholesterol test done and it should be repeated between the ages of 17 and 21. The reasoning behind the two ages of testing goes like this. Cholesterol levels in young children rise to adult levels by about age 2. They then go up and down through out childhood until puberty. Cholesterol level drop during puberty and then slowly rise back to adult levels. So the two testing times are before and after puberty. Right now the recommendation is that only children who have a family history of heart disease and other risk factors should have their cholesterol checked. The American Academy of Pediatrics and other organizations claim that if they dont screen all children they will miss 30% to 60% of children with cholesterol problems.


This is where I think the plan goes off the rails. If we universally screen all children for cholesterol problems, what are we going to do with that information? If your doctor told you your 11 year old girl had high cholesterol and that high cholesterol made it more likely she would have a heart attack or stroke when she was older, what would you do? I think many parents would demand a cholesterol medication for their the child. We already know many parents demand an antibiotic for their child with a cough whether or not the doctor thinks the infection is caused by bacteria. I think many parents would demand a cholesterol medication for their child. At the moment, the most common cholesterol medications are the statins.


If you are 45 years old, diabetic, a smoker and your doctor says you need a statin because your cholesterol is too high, listen to her. We have lots of evidence to say the statins will prevent heart attacks and strokes in patients like you. We have very little if any evidence saying treating children with statins does anything good. Statins have only been around for about 30 years and have a very good safety record. If you put an 11 year old on a statin, she might be on it for 50 years or more. We simply dont know what happens to a person being on a statin that long. Statins can cause birth defects. This isnt a concern when you put a 50 year old woman on a statin, but it certainly is when you start an 11 year old girl on one.


What should be done with children with cholesterol problems? Reduce the amount of fat in their diet. Add one hour of moderately vigorous exercise every day to the childs activities. Limit time in front of a screen to less than 2 hours per day. Eliminate sugary drinks from their diet and limit the amount of sugary food they eat. Instead of spending money on screening all children for high cholesterol and run the risk of many children being put on medications, we should spend money elsewhere. How about mandatory daily physical education in school from age 5 to 18? How about taxes on junk food and soft drinks? How about programs to make fruits and vegetables cheaper? It just seems to me that cholesterol screening in children is as wrong headed as saying the world is going to end December 21, 2012.



The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.


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