Kids and Cholesterol

Your Pediatrics paper noted that "patients begun on a statin during adolescence will receive a cumulative dose that far exceeds that which most adults have received." If kids do go on these drugs, can they ever go off? Or are they basically going to be on the drugs for life?
It's an interesting question. One would hope that if you're talking about a kid who is overweight, that can change—the kid could lose weight and come off the drugs. In the future, we'll also probably be able to do non-invasive imaging of the arteries.

So docs could look at kids' arteries directly and say, "You're done."
Right: "You need to take a drug holiday for a while." I tell my patients it will be about five years before we have that kind of imaging. Once we have it, it'll be easier to make a case for treating some kids. But right now, treating risk factors without knowing about the kids' arteries is less than ideal.

Do you think that eventually statins could be used broadly in kids—not just the 1 percent but a larger group?
It's too soon to say. Our first obligation is to address a public health crisis. Part of the issue with these guidelines is that the problem has its roots in the obesity epidemic. It's not that obesity raises cholesterol that much, but it's a complicating factor—it would push a child with high cholesterol into a higher-risk group. What we should be focusing on is collectively addressing the problem we've created for our children. They're overweight and they're going to suffer as a consequence. We need to figure out how to help them in the school system and with after-school programs. Everybody can play a role in that, not just doctors and drug companies.

© 2008