Media Firestorm Over Pediatric Statins Misses the Point

September 24, 2008

When the American Academy of Pediatrics released revised recommendations for the management of hypercholesterolemia in children this year, a media firestorm erupted over the inclusion of statins as potential first-line pharmacologic agents. But the epidemic of childhood obesity has forced pediatricians to balance the unknown risks associated with pharmacologic therapy in children against the risk that failure to treat could lead to heart attacks and other complications in young adulthood, according to a Perspective article published in the Sept. 25 issue of the New England Journal of Medicine.

WEDNESDAY, Sept. 24 (HealthDay News) -- When the American Academy of Pediatrics released revised recommendations for the management of hypercholesterolemia in children this year, a media firestorm erupted over the inclusion of statins as potential first-line pharmacologic agents. But the epidemic of childhood obesity has forced pediatricians to balance the unknown risks associated with pharmacologic therapy in children against the risk that failure to treat could lead to heart attacks and other complications in young adulthood, according to a Perspective article published in the Sept. 25 issue of the New England Journal of Medicine.

Sarah de Ferranti, M.D., and David Ludwig, M.D., Ph.D., of Children's Hospital Boston and Harvard Medical School, note that the new recommendations mostly represent an incremental change in practice that emphasizes improved screening and diet, and lowers the threshold for pharmacologic therapy from 10 to 8 years.

The authors cite statistics showing that pediatric obesity has tripled during the past 25 years and that a majority of adolescents in some minority groups are either overweight or obese, and suggest that failure to address the epidemic could result in the first decline in life expectancy in more than a century.

"The intense media coverage of the new statin policy may have shined a light on the profound cultural disconnect between our willingness to treat disease with drugs and our reluctance to institute preventive public health measures," the authors conclude. "These measures would include regulating food marketing to children, improving the quality of nutrition at school, promoting physical activity at school and elsewhere, and providing greater funding for obesity prevention and treatment programs. If the AAP recommendations have helped bring this disconnect to light, then their greatest effect may be not on the children who will receive pharmacologic treatment for hypercholesterolemia but rather on the adults who are responsible for the world in which our children live."

One of the authors of the report has received grants from GlaxoSmithKline.

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