April 15, 2015
Pediatric Guidelines Would Put More Teens, Young
Adults on Statins

Boston—More than 400,000 additional teens and young adults with elevated low-density lipoprotein cholesterol (LDL-C) levels would go on statins if pediatric guidelines are followed as opposed to adult guidelines, according to a new study.

Background information in the article, which was published online recently by JAMA Pediatrics, notes that risk factors for cardiovascular disease, including abnormal cholesterol levels, often emerge during adolescence.

Yet two leading treatment guidelines—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—make different recommendations regarding statin use at that point, which is a typical age for transitioning away from pediatric care.

Study authors, led by researchers from Boston Children’s Hospital, suggest that the contradictory guidelines could lead to confusion in clinical practice.

For the study using data from the National Health and Nutrition Examination Survey (NHANES) from January 1999 through December 2012, the research team compared the proportion of youths 17 to 21 years old who met criteria for pharmacologic treatment of elevated LDL-C levels under pediatric versus adult guidelines. Their analysis was performed from June through December 2014.

Results indicate that, of the 6,338 young people included in the analysis, 2.5% would qualify for statin treatment under the pediatric guidelines compared with 0.4% under the adult guidelines. With extrapolation to the U.S. population of 20.4 million people age 17 to 21 years, 483,500 individuals would be eligible for statin treatment under the pediatric guidelines compared with 78,200 under the adult guidelines, a difference of about 400,000, according to the study.

The actual number treated is likely to be much lower because of several factors, according to the authors, including less-than-universal screening in the age group, issues with medication adherence, and physicians or patients disagreeing with the guidelines.

The study points out that participants meeting pediatric criteria had lower average LDL-C levels—167 versus 210 mg/dL—but higher proportions of other cardiovascular risk factors, including hypertension, smoking, and obesity compared with those who met the adult guidelines.

“Given the current uncertain state of knowledge and conflicting guidelines for treatment of lipid levels among youth aged 17 to 21 years, physicians and patients should engage in shared decision making around the potential benefits, harms, and patient preferences for treatment,” the authors conclude. “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.”

In addition, they suggest, “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.”

U.S. Pharmacist Social Connect