Statins in youngsters

tallaght01

Following on from previous question about statins in kids.....I might actually have to start prescribing them soon, coincidentally.

There's war over this. I'm just going to read it now, but I thought I'd post it up here in case anyone else fabcied reading it.

The American Academy of Paediatrics is apparently now recommending using statins in certain kids, depending on their LDL levels/diabetes status.

It might affect more than just paediatricians, as in some places kids go to adult services once they are 14 years old.

http://aappolicy.aappublications.org/cgi/content/full/pediatrics;122/1/198

It's a giudeline that's been attrcating huge amount of press coverage, but I'm not sure what the fuss is, but I'll read it and see.

DrIndy

my big issue with this is WHY are we prescribing statins. The reason they need them is because they are too fat!

kids should not be fat - if they are healthy, only a tiny proportion actually need statins.

I see this policy as head in the sand acceptance of the reality that kids in america are grossly and disgustingly overweight and now it is becoming a socially accepted norm and ignoring the cause - simply treat the consequence!

Children should NOT be having heart disease unless they have rare clotting disorders such as antiphospholipid syndrome.

tallaght01

I don't know DrIndy. I mean, the artherosclerotic process is very likely to begin in childhood/adolescence. Also, the problem with grossly obese kids is that they're very much reliant on their parents for their diet. Most of the real chubbers that I've come across in work have had really poor parenting. We try and get the dieticians etc involved, but it can be very difficult to sort out. Is it fair to punish the child because of their parents?That's not to say we shouldn't try and implement preventative strategies.

Fair enough, they're unlikely to get CVD in childhood, but is it not sensible to try and prevent a process that could kill them in adulthood?

I don't think it's a head int he sand approach. Adults get treated all the time for smoking/alcohol/drug/diet related illnesses that could be treated by them giving up any of the above.

siochain

what would be you though's on kids with elevated lipoprotein (a) been prescribed statins? And if you agree what would be a suitable age to start and is there know studies on the longer term side affects of statins started at a young age?

tallaght01

Hi Siochan. I'm not aware of any large scale studies that have been done specifically on statins in kids, and their efficacy. Presumbaly, if they're licensed for kids, then they've undergone the usual safety checks (although a lot of drugs we prescribe for kids are unlicensed).

IN terms of LDL levels, there's suggested levels in the new guidelines. If you're above the 95th centile for your age and gender, youre said to have high levels.

There's guidelines for when we should start treatment, depending on other cardiovascular risk factors and diabetes status. But I'm not sure those levels are based on good evidence, and I suspect that situation will evolve, as more studies are carried out.

In terms of age, they say you can start at about 8 years old.