Kids Can Have High Cholesterol Too
Posted Feb 4, 2013
Parents plan ahead for everything from how often the diaper service will come to how they'll pay for their children's college education.
Most don't plan on high cholesterol setting their children up for early heart disease.
Doctors say they should. One out of every dozen kids age 6 through 19 has high cholesterol.
The American Heart Association and others point to compelling evidence that atherosclerosis -- plaque buildup in the arteries -- or its precursors begin in children as young as 2. Though a recent government study showed the proportion of kids with high cholesterol has fallen in the past decade and average overall cholesterol levels declined slightly, high rates and early onset of obesity have cardiologists predicting a surge in patients with cholesterol-fueled problems down the road. Cardiovascular disease is already the nation's No. 1 killer.
"It's like seeing the tide go out before a tsunami," says Dr. Laurie Armsby, a pediatric cardiologist at Doernbecher Children's Hospital. If children don't act now to trim pounds and cholesterol levels, she says, significant numbers will have heart attacks in their 30s and 40s, altering the course of their lives and burdening the health-care system.
The subject of children and cholesterol has proved sticky.
Last November, a government-appointed panel of health experts recommended that all children get a cholesterol check between age 9 and 11, and again between 17 and 21, regardless of family history; previously, doctors typically only screened children considered at high risk.
Some health-care providers balked at the recommendation. They worried that universal testing would lead to medicating kids who might not need it.
Still, even the controversy has an up side: getting parents thinking about their children's heart health, talking to pediatricians about it and tuning children in to the necessity of healthy food choices and vigorous daily exercise.
Armsby promotes screening for most kids after age 2. She reasons that when you take children with a family history of high cholesterol or premature cardiovascular disease, or if the family history is unknown -- "the kicker," as she calls it -- "that's 90 percent of the population." Children who are overweight, have high blood pressure or have been exposed to tobacco are at risk, too.
"Basically," she says, "the National Cholesterol Education Program says anyone at risk should be checked after 2.
"Then the debate comes," Armsby says. "What if we find it?"
Studies show that statins, widely prescribed for adults with high cholesterol, appear safe for children. Yet, no one wants to medicate them unless it's absolutely necessary.
When Armsby sees patients with high cholesterol in her practice at Doernbecher's pediatric lipidemia clinic, she first tries to figure out why their numbers are up. She and colleagues ask families about their dietary history, have them track what they eat in daily diaries, and inquire about exercise.
Usually, she says, she'll focus on two or three foods kids eat consistently that boost their weight, their cholesterol and their diabetes risk. She persuades them to step away from just those few items, replacing them with healthier choices, and to make sure they incorporate exercise.
"Once that change becomes the new norm," she says, 'we look at the rest of their diet and do the same thing ... make slow, lasting alterations in their lifestyle."
"I'm a mom myself," she says, "so I understand what it's like to live a hectic, working lifestyle with a family and provide a heart healthy diet, and keep them active ... I understand the pull toward fast food."
But she's also watched children and entire families change their ways, Armsby says.
"You have to make sure the parents do this for the entire family," she says. "They need to create an environment in which the child will be healthy."
If after six months a child's cholesterol is still too high, she might prescribe a statin, as she did for Nicholas Armbrust, 11, of Eugene. He was an active kid, wasn't overweight and ate so healthfully he asked for a salmon dinner for his second birthday.
Genetics, though, worked against him.
His mom, Julie Armbrust, 39, was stunned to learn that she had soaring cholesterol when she was a fit, thin-as-a-rail, vegetarian, 18-year-old college freshman. The desired total cholesterol level is less than 170, but hers was 450. She discovered it ran in her family, showing up even in her 2-year-old nephew, so had Nicholas tested at 2. His cholesterol was nearly 400. His 6-year-old brother, Patrick, has the same problem.
Nicholas started on statins at 8; Patrick likely will at the same age.
"I have genuine concerns around how statins affect my children," Armbrust says, "but ... our arteries are hardening with cholesterol, so we have to weigh the advantages and disadvantages. For us, it's imperative to have statins in our system."
The drug has done the trick, lowering Nicholas' cholesterol.
Still, he and his family make sure they get at least 30 minutes of physical activity each day. His breakfast typically includes cereal or low-fat yogurt and fresh fruit; lunch might be a sandwich and more fruit; low-fat mozzarella sticks are a favorite snack; dinner includes low-fat meat, fresh vegetables and fruit, a little bit of starch. His mother says her sons share her sweet tooth and they indulge it, but not more than once a day.
In other words, they follow Armsby's advice: They don't use the medication as a substitute for a heart-healthy lifestyle.
-- Katy Muldoon; twitter.com/katymuldoon
The article reflects a correction published Aug. 29: Dr. Laurie Armsby is director of Doernbecher Children's Hospital's pediatric lipidemia clinic. Her first name was incorrect in a story in Wednesday's Living section.
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