Twenty percent of all teens in the United States — and more than four out of 10 obese teens — have abnormal cholesterol levels, according to a report released by the U.S. Centers for Disease Control and Prevention late last week. The findings likely will prompt physicians to alter they way they treat and counsel youngsters. The findings also could have an impact on the on-going discussion about the best way to provide efficient, equitable and cost-effective health care in the United States.
Whether it is low levels of HDL (good cholesterol), high levels of LDL (bad cholesterol) or high levels of triglycerides, another type of blood fat, abnormal levels can raise the risk for heart disease, the nation’s leading cause of death. Unhealthy cholesterol levels and related problems once were associated almost exclusively with adults. No more. Children, the study indicates, are at risk. That, in turn, spurs questions about whether and how youngsters should be tested and treated for the condition and about the short and long-term costs, benefits and risks and of such protocols.
There are guidelines in place. In 2008, the American Academy of Pediatrics advised aggressive cholesterol testing and treatment for children, especially those who were overweight or obese. Controversy dogged the advice, primarily because it recommended the use of cholesterol-lowering statin drugs in kids as young as 8 who had high levels of LDL (bad) cholesterol that could not be reduced through diet or exercise. Other guidelines at the time, however, questioned the validity of cholesterol testing in the young. The result was predictable.
Many parents were unsure whether to have their kids’ cholesterol levels tested and what path to follow if the tests indicated the levels were abnormal. The new CDC study confirms the need for wider testing — particularly among youngsters with high risk factors, including a family history of cholesterol problems. It provides little insight, though, about the use of statins. That remains a topic of heated discussion.
Screening the young does make sense. It allows pediatricians to determine who is at risk and what treatment, if any, is advisable. It also provides parents with the knowledge necessary to make informed decisions about their child’s care. Besides, addressing cholesterol problems in childhood is far more efficacious than doing so in adulthood. Early intervention can play a major role in preventing or controlling costly and life-threatening complications later in life.
Truth is, few youngsters need to be on cholesterol-lowering drugs. Expanded testing will help identify those who need aggressive treatment as well as those who will benefit from more passive intervention to reduce cholesterol. Indeed, the new report does not change an important medical fact.
Lifestyle changes — healthy eating habits and regular physical activity — remain the method of choice to lower the number of kids (and adults) at risk for cholesterol problems and heart disease. The new study does not change that.