In July the American Academy of Pediatrics created a media sensation by formally recommending hyperlipidemic children as young as 8 years old get cholesterol lowering drugs to prevent future heart problems. This position continues to evoke strong discussion and debate in both the lay and medical literature. What do we know about lipids and atherosclerosis in children?

1. Children as young as 8 years old with elevated cholesterol develop atherosclerotic lesions in their aorta, carotid and coronary arteries. This clearly has been established in two large autopsy studies in children who died in accidents. Also, we know that the amount of atherosclerosis in these children was proportional to the elevation in their cholesterol. Atherosclerosis is the disease process that ultimately causes heart attacks and strokes.


2. Risk factors such as elevated cholesterol in children “track” into adulthood. That means that dyslipidemic children tend to turn into dyslipidemic adults and children with normal lipids are likely to turn into normal adults.


3. The new guidelines recommend drug therapy be started in children only when aggressive diet and lifestyle changes for 6 to 12 months fail to lower the cholesterol. (With the exception of rare genetic disorders with extreme cholesterol elevation when drug therapy is started at the same time as diet and lifestyle.)


4. Statins, the main class of medication used to treat elevated cholesterol, have not been studied long term in children. Multiple studies have shown statins are safe for children to take for up to two years but there is no data on longer treatment lengths.


5. In children with genetic dyslipidemia, statin therapy over a two year period resulted in a significant reduction in the amount of atherosclerosis in their carotid arteries compared to similar children who did not receive statin therapy.

In conclusion, children with dyslipidemia first should be treated aggressively with diet and life style therapy. Emphasis should be placed on daily exercise and a balanced diet low in saturated fat and cholesterol. If these interventions, followed for 6 to 12 months fail to reduce the cholesterol level then strong consideration should be given to starting drug therapy as recommended by the American Academy of Pediatrics, the American Heart Association and the National Lipid Association.