Heart risk test urged for kids

Doctors release new policy on cholesterol screening

July 07, 2008|By Euna Lhee | Euna Lhee,SUN REPORTER

Keith Miller leads what doctors call a healthy, active lifestyle. The suburban Baltimore teenager has always loved sports and plays soccer competitively. He avoids eating pizza and junk food.

But despite all that, Miller had cholesterol levels nearly five times his average peer and underwent a double bypass surgery to repair his heart two years ago when he was 15.

Though open-heart surgery remains unusual in young patients, medical experts fear that cholesterol levels are rising at an alarming rate. Often, as in the case of Miller, the culprit is genetics. But for others, it is linked to what some say is an "epidemic" of obesity among American youngsters.

As a result, the American Academy of Pediatrics is scheduled to release today a new policy statement on cholesterol screening and treatment options for children - including those as young as 2. The academy advises cholesterol screening of children and adolescents with a family history of high cholesterol or heart disease. The recommendation also includes patients whose family history is unknown or who have risk factors for heart disease, including obesity, high blood pressure, cigarette smoking or diabetes.

"This policy seems to say 'screen everyone,' but it actually stops short of universal screening," said Dr. Frank Greer, chairman of the academy's Committee on Nutrition and one of two authors of the report. "It exempts those patients with no risk of cardiovascular disease, either in themselves or their families. But most everyone will qualify for screening."

Screening should start as early as 2, but no later than age 10. If results are normal, patients should be retested in three to five years. The new policy calls for more aggressive treatment, including with medication, among youngsters found to have high cholesterol levels.

The previous policy, issued in 1998, also recommended screening for children with family histories or risk factors. But the new guidelines put a greater emphasis on the need for such screening and for subsequent treatment, given the expanding waistlines, poor eating habits and sedentary lifestyles of American youth.

Doctors wrote that the report, Lipid Screening and Cardiovascular Health in Childhood, has taken on "a new urgency, given the current epidemic of childhood obesity."

Obesity rates in children have increased fourfold since the early 1970s. Now, nearly one out of five kids is obese, according to the Centers for Disease Control and the National Center for Health Statistics. Along with high cholesterol, obesity is a major risk factor for heart disease, which kills one person every 37 seconds and is the leading cause of death in the United States, according to the American Heart Association.

"There is a large discussion of obesity in America because this is the first generation of children that has a lower life expectancy than their parents' generation," said Dr. Daniel Levy, a pediatrician and the national spokesman for the academy. "The principal reason for that is more children are obese."

Doctors hope to fight mortality rates from heart disease by tracking high-risk kids and intervening at a younger age. Studies, however, are unclear in establishing a childhood cholesterol threshold that predicts heart disease in adulthood.

"There is a higher concern about obesity these days, but this report is not specifically about obesity," said Dr. Stephen Daniels, pediatrician-in-chief at The Children's Hospital in Denver and the other author of the report. "Many kids with high cholesterol are not overweight, and in these cases, there's usually a strong genetic component."

That was certainly the case with Miller, whose mother asked that his high school and residence not be disclosed.

His father and mother both have high cholesterol, as well as his paternal grandmother.

He often experienced shortness of breath when exercising, which his parents attributed to mild asthma and a slight heart murmur. He then complained of fatigue and double vision on the playing field. His parents took him to a cardiologist and were shocked to discover the gravity of his condition.

At age 15, Miller had developed significant stenosis, a narrowing of a blood vessel, above his aortic valve - a condition typically seen in middle-aged individuals with a history of heart disease. In addition, his coronary arteries, the vessels that bring blood to the heart muscle, were almost completely clogged by calcium deposits.

Miller underwent heart surgery in 2006 to repair his aortic valve and to clear his coronary arteries. Soon after, he was diagnosed with familial hypercholesterolemia - a genetic disorder characterized by high cholesterol levels affecting one out of 500 children in the United States.

Since then, Miller, now 17, has been put on four cholesterol-lowering medications. His cholesterol levels have gone down significantly, but not enough, his mother says. He needs another procedure to further lower his cholesterol levels, his doctor said.

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