Applying pediatric cholesterol guidelines would increase statin use

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An additional 400,000 patients, aged 17 to 21 years would be treated with statins if they were treated under the pediatric guidelines for elevated low-density lipoprotein cholesterol levels compared with the adult guidelines, findings published in JAMA Pediatrics indicate.

“Health-care practitioners who care for adolescents transitioning to adulthood often face incongruent recommendations from pediatric and adult guidelines for treatment of lipid levels,” noted Holly C. Gooding, MD, MSc, of Tufts Medical Center in Boston, Massachusetts, and colleagues.

To compare the proportion of adolescent patients meet criteria for pharmacologic treatment of elevated low-density lipoprotein cholesterol (LDL-C) levels under pediatric versus adult guidelines, the investigators performed a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) population. Surveys were administered from January 1, 1999 through December 31, 2012, and included responses from 6,338 individuals aged 17 to 21 years.

Under the pediatric guidelines, 2.5% of the patients surveyed would qualify for statin treatment while only 0.4% would qualify under the adult guidelines. When the researchers extrapolated data to the 20.4 million people in the United States population, 483,500 patients would be eligible for statin treatment under the pediatric guidelines compared with only 78,200 under the adult guidelines.

The patients who met the pediatric criteria for statin treatment had lower average LDL-C levels (167 versus 210 mg/dL) but higher proportions of other heart health factors such as smoking, obesity, and hypertension , compared with those who met the adult guidelines.

“The 2013 American College of Cardiology and American Heart Association guidelines recommend shared decision making with patients for whom data are inadequate, including young people with a high lifetime risk for atherosclerotic cardiovascular disease,” concluded the scientists.

“Patients and clinicians should clearly address other modifiable risk factors, including optimizing diet, exercise, and weight and promoting abstinence from tobacco, as strongly recommended by both the pediatric and adult guidelines.”

Statin use increases with application of pediatric cholesterol guidelines
Statin use increases with application of pediatric cholesterol guidelines

Application of pediatric guidelines for lipid levels for persons 17 to 21 years of age who have elevated low-density lipoprotein cholesterol (LDL-C) levels would result in statin treatment for more than 400,000 additional young people than the adult guidelines, according to an article published online by JAMA Pediatrics.

Adolescence is a common time for the emergence of risk factors for cardiovascular disease, including abnormal cholesterol levels. The 2011 National Heart, Lung, and Blood Institute Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents and the 2013 American College of Cardiology and American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults differ in their recommendations regarding statin use.
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