A sad milestone: Kids and cholesterol drugs

New guidelines are a regrettable development in health care.

Last update: July 7, 2008 - 7:47 PM

Monday's proclamation by the American Academy of Pediatrics (AAP) was cause for disbelief and no small measure of sadness. In a nation where about a third of kids are overweight, the AAP announced that children as young as 8 may need cholesterol-lowering drugs. Not all kids, but those with high levels of so-called "bad" cholesterol and other cardiovascular risk factors, such as a family history of early heart attacks or Type II diabetes.

The AAP is one of the most influential and respected groups in American medicine, and it issues guidelines on everything from childhood vaccines to infant sleep positions. Its announcement on cholesterol drugs is a shocking and regrettable milestone. As a nation, our health is so poor that small children may now need to pop pills to counteract high-calorie diets and sedentary lifestyles.

In pediatric exam rooms across the Twin Cities this week, doctors were just beginning to grapple with the AAP recommendation and how it will play out in real life. It didn't come as a surprise to many that the organization went as far as it did. Type II diabetes, once thought of as a plague of the elderly, is increasingly seen in children. In recent years, doctors say it's stunning how many young patients are grossly overweight. Medical advances have also revealed that atherosclerosis (hardening of the arteries) can begin in childhood.

The AAP still considers a healthy diet and more exercise key treatments for kids at high risk of heart disease. But as one Twin Cities pediatrician said with a sigh Monday, it's a losing battle against video games, the Internet and ubiquitous fast-food joints and their commercials.

While some small studies suggest that cholesterol drugs are safe and effective in kids, the risk of the AAP recommendation is that the pills become an easy out for some parents. It's daunting enough for adults to improve their own eating habits and get more exercise. Motivating kids can be even harder. Having them take a pill to ward off lifestyle risks may seem like a pretty good option.

But putting kids on cholesterol-lowering drugs should give parents pause. There can be side effects -- muscle aches, nausea, fever. Once started, the drugs are often taken over a lifetime and require ongoing monitoring. There are also no long-term studies of the drugs' safety or benefits over decades of use.

Some kids may truly benefit from cholesterol-lowering drugs; that's a decision to be made by doctors and the families of their young patients. Common sense dictates doing everything possible to avoid that exam-room scenario. Turn off the TV. Take the pizza guy off speed dial. Get outside. Most kids have built-in defenses against heart disease: high energy, active imaginations and a natural instinct to join other youngsters at play. Take advantage of it, especially now that summer's here. It's never too late -- or early -- to start healthy habits.

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