Cholesterol medicine isn't right for teen

ON CALL

March 15, 1994|By Dr. Simeon Margolis | Dr. Simeon Margolis,Special to The Sun

Q: My husband had a heart attack two years ago when he was only 45. He was found to have a high cholesterol level and was placed on Mevacor. Recently a very high cholesterol level was also discovered in my 14-year-old son. Why doesn't his pediatrician treat him with Mevacor to reduce his chance of having an early heart attack like his father?

A: Mevacor (simvastatin) is one of three drugs now available that lower blood cholesterol levels by blocking the production of cholesterol. The other two are Pravachol (pravastatin) and Zocor (simvastatin). They are commonly referred to as reductase inhibitors because they all work by inhibiting the enzyme HMG CoA reductase, which controls the formation of cholesterol, primarily in the liver.

The reductase inhibitors are generally quite effective in lowering the blood levels of total cholesterol and the amount of cholesterol carried by low density lipoprotein (LDL), which causes narrowing of the coronary arteries and other arteries, by depositing in the arterial walls.

These drugs are usually well-tolerated and have produced only one potentially serious side effect, inflammation of the muscles (myositis), especially when taken in combination with erythromycin or certain other lipid-lowering medications. However, the reductase inhibitors may also interfere with the production of other essential body substances that depend on the activity of the reductase enzyme. Although limited studies have shown that the drugs are effective in lowering cholesterol in teen-agers, there is concern that interfering with the formation of cholesterol and other essential substances may have detrimental effects on the development of children.

In addition, since these drugs have only been used in large numbers of people for about six years, it is possible that they might produce serious long-term complications when taken for many years. For all of these reasons, treatment with reductase inhibitors is usually deferred at least until age 18.

protect him from a heart attack as he grows older.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

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