County doctors split on prescribing cholesterol drug for children
The nation's largest professional pediatrics group sparked heated debate this week when it recommended that drugs may be used to lower cholesterol in children as young as age 8.
The move lowered by two years the American Academy of Pediatrics' threshold for using drugs to treat children considered at high risk for heart disease. In so doing it also shifted attention away from its other, more benign suggestions.
Many doctors have been highly critical, citing a lack of data on the long-term effects of cholesterol-lowering drugs, or statins.
"It's ridiculous," said Santa Rosa pediatrician Tom Zembal. "I find it very difficult to think about putting a kid on a chronic drug like this for life."
But for every pediatrician like Zembal you can find another like Faye Lundergan.
"It's amazing so many people have their panties in a bunch," Lundergan said. "The new guidelines are so soft and wishy-washy. It says, 'If, if, if.' "
Lundergan has a private pediatric practice in Petaluma and is a member of the AAP's Obesity Special Interest Group.
She said she has suggested statins -- the type of cholesterol-lowering drugs at issue -- and gastric bypass surgery as last resorts in an effort to motivate lifestyle changes for the mother of a 200-pound, 8-year-old who was refusing to heed her warnings.
"He couldn't even get up on the exam table without being short of breath," Lundergan said. "We would argue diet and exercise ad nauseam, and he weighed more every time."
Childhood obesity poses health risks typically found in adults -- type 2 diabetes, high blood pressure, heart disease -- and is a growing problem in Sonoma County, where health officials call it an epidemic.
It's such a serious problem that Ari Hauptman, chief of pediatrics at Santa Rosa's Kaiser Permanente Medical Center, and his 16 pediatricians made it a target health issue this year.
Hauptman views diabetes as the most immediate concern for obese children and echoed other local doctors by planning to continue suggesting diet and exercise over drugs to prevent health risks such as heart disease.
Though statins have been shown to be safe, the AAP recommendation appears to have been made "without a lot of study and thought," Hauptman said.
The statin Pravachol has already received approval by the Food and Drug Administration for use in children as young as 8.
Dr. Stephen Daniels, chairman of the committee that made the statin recommendation, said he was "a bit surprised" by the reaction.
The panel also called for screening of children with a family history of heart disease starting at age 2.
"The hard part about these studies is you need to definitely show that treating children would prevent heart attacks later in life. But we can't do that for another 30 to 40 years," Daniels said. "The question is what do you do in the interim?"
Statins have been shown to lower cholesterol in the small percentage of high-risk children with a genetic predisposition to heart disease, he said.
The AAP's new guidelines apply to children with "bad" cholesterol," which can be calculated as a low-density lipoprotein (LDL) measurement of 160, and a family history of heart disease or two other risk factors.
But because data are lacking on long-term use, Healdsburg pediatrician Damian Marsden said he does not recommend it.
He has three young patients who are brothers with "alarming, sky-high cholesterol" because of a familial trait exacerbated by a high-fat diet, he said.
He consulted with a pediatric lipid expert who advised lifestyle changes, he said, which meant a tough cultural shift.
"You can't just say, 'You can't eat carnitas and tacos and enchiladas and quesadillas and now just eat carrots and celery,' " he said. But no pediatrician he knows would recommend statins for kids, he said.
"It's just not an established practice yet, and I don't know if it will be," Marsden said.
But in today's "convenience culture" fueled by advertising, cholesterol drugs could be tempting for some, said Dr. Alan Greene, clinical professor of pediatrics at Stanford University and founder of DrGreene.com.
A third of Sonoma County fifth-graders fail to meet the state's fitness standards for healthy weight and data shows nearly a third of fifth-graders in Santa Rosa are considered obese, according to county health experts.
Nearly 45 percent of the county's 5 to 14 year olds are obese or overweight, said Christina Bekin, a county health specialist. The county's public health director, Dr. Mary Maddux-Gonzalez, refers to the dramatic, rising obesity rate as "epidemic."
She said the county will continue emphasizing exercise and healthy eating -- "regardless of any changes in recommendations for drugs."
Staff Writer Shadi Rahimi can be reached at 521-5280 and firstname.lastname@example.org.