by Sarah Boseley
Furore over heart drugs plan for obese children
· British experts agree wider use needs to be discussed
Children as young as eight with high cholesterol levels should be put on statins to reduce their risk of heart disease, doctors in the United States have recommended.
But the numbers of obese and overweight children are soaring on both sides of the Atlantic and experts in the UK, who are already treating small numbers of very high risk children with statins, said it was time wider use of the drugs was discussed.
Most doctors agree that the use of statins for some children whose genetic inheritance puts them seriously at risk of death from a heart attack in their 20s or 30s is justified. In guidance due next month, the National Institute for Healthcare and Clinical Excellence (Nice) is expected to say statins can be given to the one in 500 children with the FH (familial hypercholesterolaemia) gene – which gives them a 50% chance of heart diseases – after the age of 10.
But the American academy has further pushed back the boundary. It wants cholesterol screening for all children with a family history of high cholesterol or heart disease, for children whose family history is unknown and for those with obesity, high blood pressure or diabetes between the ages of two and 10. If any of those over the age of eight have particularly high cholesterol levels, it says, statins should be considered.
The academy also says that babies in whom obesity or overweight is considered a problem by the age of 12 months should be given reduced-fat milk.
"We are in an epidemic," said Jatinder Bhatia, a member of the academy's nutrition committee, which made the recommendation, and professor and chief of neonatology at the Medical College of Georgia in Augusta. "The risk of giving statins at a lower age is less than the benefit you're going to get out of it."
But a number of doctors in the US expressed strong reservations yesterday about the use of drugs in children whose most urgent need is to get more exercise and eat a more healthy diet.
"What are the data that show this is helpful preventing heart attacks? How many heart attacks do we hope to prevent this way? There's no data regarding that," said Darshak Sanghavi, a paediatric cardiologist and assistant professor at the University of Massachusetts Medical School told the New York Times. Others expressed concern at the public health message the prescription of pills to overweight children might give.
But experts in the UK said that statins were already being given to children as young as six who had the FH gene and that discussion of their use was welcome. Chris Hendriksz, consultant in inherited metabolic disorders at Birmingham Children's Hospital, said the US guidelines were controversial but that he agreed with them. "I lost an eight-year-old with hypercholesterolaemia about 15 years ago," he said. "I could never believe it could happen that early. Things like that change your view." Hendriksz said the FH gene might not be the only genetic reason that fathers die of a heart attack at 25 or 30 in some families. In his clinic, he said, about a third of the children were on statins and two-thirds on diet and lifestyle modifications only.
George Rylance, of the Royal College of Paediatrics and Child Health, said he would expect anxieties from parents and the public if the college produced a statement like that of the US academy, but he welcomed their recommendation – "not only the text, but the debate it engenders", he said. He also felt that having the FH gene was not the only reason why children should be prescribed statins to keep their cholesterol down.
"We see families all the time where people are dying of coronary artery disease and they may not have a gene we recognise but there is something there."
Cathy Ross, a cardiac nurse with the British Heart Foundation, said that it was important to be sure there was a genetic component to the high cholesterol reading. "We should always eliminate other possible reasons, like a child's diet and lack of activity and weight in proportion to their height," she said. Counselling parents on diet and exercise should be tried first. "You don't give an adult statins without implementing lifestyle interventions."
