If the new guidelines issued by the U.S. National Heart, Lung, and Blood Institute (NHLBI) are used, the U.S. would have nearly half a million college-aged kids taking statins, a drug used to lower cholesterol levels.
Boston Children's Hospital researchers, led by physician Holly Gooding, extracted data from the National Health and Nutrition Examination Survey (NHANES) from January 1999 to December 2012 and found out that, of the more than 6,300 persons aged 17 to 21 years old included in the survey, 2.5 percent would be recommended to take in cholesterol-lowering statins under the new pediatric guidelines, compared to the 0.4 percent under the adult guidelines.
Taking in the entire U.S. population of 17 to 21-year-olds, that number would amount to 483,500 individuals in that age range taking statins, compared to the 78,200 under the adult guidelines.
The adult guidelines recommend that individuals with 210 mg/dL of low-density lipoprotein (LDL), more commonly known as "bad" cholesterol, turn to high-intensity statin-based therapy to lower their LDL. Under the pediatric guidelines, the minimum amount of LDL recommended for statin-based therapy is 167 mg/dL, but young adults who met the guidelines also have higher rates of heart disease risk factors, such as high blood pressure, obesity, and smoking.
The guidelines released by the NHLBI are not strict rules physicians must live by but suggestions that patients must speak with their doctor about. The researchers advise all individuals concerned about the pediatric guidelines to "engage in shared decision-making around the potential benefits, harms, and patient preferences for treatment." In fact, the American College of Cardiology (ACC) and the American Heart Association (AHA) still recommend that young adults must have higher LDL levels before being prescribed statins.
At least one expert, however, advises to take the pediatric guidelines seriously, saying that the studies taken from ACC/AHA "are based solely on randomized controlled trials aimed at lowering events such as heart attacks and strokes."
"These randomized controlled studies were not intended to study the impact of statin therapy in patients ages 17 to 21," says Rubin Cooper, chief of pediatric cardiology at the Cohen Children's Medical Center in New Hyde Park, New York. "However, considerable evidence now exists linking the development of atherosclerosis, or hardening of the arteries, to risk factors in childhood and adolescence."
Suzanne Steinbaum of New York City's Lenox Hill Hospital, however, disagrees. Steinbaum, a preventive cardiologist, says statin therapy should be a "last resort" and treatment for young adults should focus on implementing a healthy lifestyle.
"Regardless of the guidelines, we need to not have this younger generation rely on medication, but instill in them what healthy food choices, exercise, and smoking cessation means before simply giving them a pill," she says. "In the short term, it may reduce their cholesterol numbers, but ultimately with obesity and hypertension, their risk of heart disease will continue to escalate."
The study is published in the JAMA Pediatrics journal.
Photo: Adam Chamness | Flickr
