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More than 400,000 additional young people would receive statin treatment with the application of pediatric vs. adult guidelines for those aged 17 to 21 years with elevated LDL cholesterol, according to data published in JAMA Pediatrics.
“Adolescence is a common time for the emergence of risk factors for cardiovascular disease (CVD), including dyslipidemia,” the researchers wrote.
They noted that the 2011 National Heart, Lung, and Blood Institute Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents recommend universal screening of lipid levels for those aged 17 to 21 years and pharmacologic treatment with statins for those with LDL cholesterol levels of at least 190 mg/dL without other risk factors or at least 130 mg/dL or 160 mg/dL if additional risk factors are present.
However, these recommendations differ from those issued by the American College of Cardiology and American Heart Association published in 2013, the researchers noted. The 2013 guidelines only recommend pharmacologic therapy for people aged younger than 40 years if LDL cholesterol is 190 mg/dL.
“Because 17 to 21 years is a typical age for transition from pediatric to adult-centered care, these disparate approaches may lead to confusion in clinical practice,” they wrote.
To investigate how the different guidelines would affect how many young people being treated with statins, the researchers compared the proportion of people within this age group who met criteria for pharmacologic treatment under pediatric vs. adult guidelines using data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2012.
Results indicated that 2.5% (95% CI, 1.8-3.2) of the 6,338 people aged 17 to 21 years included in the analysis qualified for statin treatment under the pediatric guidelines vs. 0.4% (95% CI, 0.1-0.8) under the adult guidelines.
After extrapolating these proportions to the number of people aged 17 to 21 years in the U.S. population the researchers found that 483,500 (95% CI, 482,100-484,800) young people would be eligible for pharmacologic treatment of elevated LDL with the pediatric guidelines vs. 78,200 (95% CI, 77,600-78,700) with the adult guidelines.
They also noted that the “actual number treated is likely to be much lower owing to less than universal screening in this age group, challenges with adherence to medication regimens, and physician or patient disagreement with the recommendations.”
According to the data, those who met pediatric criteria for treatment had lower mean LDL levels (167.3 mg/dL vs. 210.0 mg/dL) but a higher proportion of other CV risk factors like hypertension (10.8% vs. 8.4%), smoking (55.0% vs. 23.9%) and obesity (67.7% vs. 18.2%) than those who met criteria under the adult guidelines.
Ultimately, the researchers concluded that, in light of the conflicting guidelines and “uncertain state of knowledge” about treatment of lipid levels in this age group, shared decision making regarding the potential benefits, harms and patient preferences between physicians and patients may be the best option.
“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 high lifetime risk for atherosclerotic cardiovascular disease,” the researchers wrote.
“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.”
