Cholesterol Screening for Children, A Boon for Drug Makers?
Late last year, an expert panel recommended cholesterol screening for children and provided a list of guidelines for that purpose. Now a trio of physician-researchers from the University of California, San Francisco, have published a commentary and pointed out some flaws with those guidelines, including a potential boon for drug makers.
High cholesterol in children related to obesity
Obesity among children has more than tripled in the past three decades, according to the Centers for Disease Control and Prevention. In 2008, more than one-third of children and adolescents were overweight or obese.
In fact, among different minority groups, the rates are even higher. The American Heart Association notes that among American children ages 2 to 19, the rate of overweight or obesity among non-Hispanic black females is 39.2%, among Mexican American males it is 40.8%, and among Mexican American females, the figure is 35%.
Among the many serious health risks associated with obesity and overweight in young people are cancer, heart disease, joint problems, and diabetes. Similarly, overweight and obese children are more likely to have risk factors for cardiovascular disease, such as high cholesterol or high blood pressure. In one sample of 5- to 17-year-olds, 70% of obese young people had a least one such risk factor.
Cholesterol screening guidelines written by a panel determined by the National Heart, Lung and Blood Institute and published in November 2011 recommend universal screening for 9- to 11-year-old children using a non-fasting lipid panel, and for use of two fasting lipid profiles for 30% to 40% of 2- to 8-year-old and 12- to 16-year old young people.
These new recommendations supercede previous guidelines that called for non-fasting cholesterol screening only for children considered to be at high risk of high cholesterol. Thus the new guidelines significantly expand the net to capture a new population of potential cholesterol-fighting drug users.
Although it may be admirable to want to stem the rising numbers of children who have high cholesterol and/or who are obese or overweight, Thomas Newman, MD, MPH, one of the authors of the commentary, notes that "You don't need a blood test to tell who needs to lose weight. And recommending a healthier diet and exercise is something doctors can do for everybody, not just overweight kids."
In addition to this objection to widespread cholesterol screening of children, Newman also pointed out that the members of the panel "made their recommendations without estimating what the cost would be. And it could be billions of dollars."
Besides the direct monetary costs, there are costs in time, lost wages, and other burdens on parents, who would need to take their children to doctors for additional visits. "Because these blood tests must be done while fasting, they can't be done at the time of regularly scheduled 'well child' visits," noted Newman.
Perhaps the most disturbing aspect of the cholesterol screening guidelines is that all the individuals on the panel who drafted the recommendations had "extensive assortment of financial relationships with companies making lipid lowering drugs and lipid testing instruments." In other words, panel members had monetary and board membership incentives to recommend expanding the population of potential cholesterol-lowering drug users.
Newman also emphasized that the review process behind the new guidelines did not provide strong evidence for the resulting recommendations. Given all of the above, plus the fact that the Institute of Medicine recommends that experts who have a conflict of interest should be excluded from panels that establish guidelines or at least have "non-voting, non-leadership, minority roles," it appears time to reassess the cholesterol screening guidelines for children to determine who will really benefit from them.
American Heart Association
Centers for Disease Control and Prevention
Freedman DS et al. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. Journal of Pediatrics 2007; 150(1): 12-17
McCrindle BW et al. Guidelines for lipid screening in children and adolescents: bringing evidence to the debate. Pediatrics 2012 Jul 23; peds.2012-1137 published online.
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