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Wider cholesterol screening for children recommended

Monday, July 14, 2008

Screenings can be given as early as age 2

SIKESTON -- If children have certain risk factors, they and their parents can expect cholesterol screenings as early as age 2.

In guidelines issued Monday by the American Academy of Pediatrics, wider cholesterol screening for children and more aggressive use of cholesterol-lowering drugs starting as early as the age of 8 was recommend in an effort to prevent adult heart problems.

"It's not something we do already," said Kevin Blanton, a pediatrician at Ferguson Medical Group in Sikeston. "We usually do them in late adolescence for obese kids."

Jeannie Stalker, a nurse at the Scott County Health Department, said it would be uncommon to perform the screenings for children at all.

"We do cholesterol testing, however we usually do it for adults," she said. "I have never done one on a child."

Representatives from the New Madrid and Mississippi county health departments said they also only conduct screenings on adults, and they don't expect any changes as a result of the new guidelines.

Blanton said the recommendation comes from studies over the years. One thing that has become clear in autopsies, he said, is the hardening of arteries, which he said starts in mid-childhood.

"They have been able to correlate that with some of the problems you see in adults," he said. "Heart disease is the leading cause of death in adults and a lot of the things that lead to that start in childhood."

Blanton said the new recommendations will change the way he practices medicine. Obesity as well as risk factors such as family history, hypertension, diabetes and abnormalities in the lipid panel will be deciding factors for whether a younger child undergoes a cholesterol screening.

According to the study, the cholesterol screening is recommended as early as age 2 and no later than age 10 if they come from families with a history of high cholesterol or heart attacks before the age of 55 for men and 65 for women. Between 30 and 60 percent of children with high cholesterol are being missed under the current guidelines, the academy predicted.

Based on levels set out by those in the study, about 5 to 10 percent of children will be "abnormal" and need that screening, said Blanton.

Proponents say there is growing evidence that the first signs of heart disease show up in childhood. With 30 percent of the nation's children overweight or obese, many doctors fear a rash of early heart attacks and diabetes is on the horizon as these children grow up.

"It's a substantial problem and it's gotten worse -- you just see it with the number of obese kids," he said. Part of the obesity epidemic is blamed on high-sugar foods, but also foods being more readily available and calorie dense.

"A lot of times the foods that are very high in calories taste very good," Blanton continued. "And, portion sizes have increased dramatically in the past 20 to 30 years and with that, you see more kids who are obese."

The new guidelines include the approval of different medicines for children as young as age 8 "especially if dietary and exercise intervention have already been done," Blanton said. The cholesterol-lowering drugs, called statins, may be children's best hope for lowering the risk for early heart attack, proponents say.

He said the underlying problem is the obesity epidemic -- which isn't so much addressed.

"It is very difficult to change folks' behavior," said Blanton. "But nevertheless, somethings that's the best option that we have."

However, there is a recommendation to help curb some caloric intake for youngsters -- a call for low-fat milk after 12 months of age.

"That's an easy way to cut back on calories," said Blanton. "A large percent of their calories do come from milk."