Table 1.
Comparison of AAP Recommendations on Hypercholesterolmia in 1998 and 2008
| Recommendation | 1998 | 2008 | |
|---|---|---|---|
| Screening | |||
| Measure nonfasting total cholesterol or fasting lipids according to algorithm | Assess fasting lipid profile | ||
| Recommended with family history of high cholesterol or early atherosclerosis | (Unchanged) | ||
| Optional with unknown family history | Recommended with unknown family history | ||
| Optional given personal risk factors | Recommended given personal risk factors. Screen every 3–5 yr beginning at 2 yr of age | ||
| Use same cutoff point? for all ages and both sexes | Use age-and sex-specific cholesterol norms (>95th percentile considered abnormal) | ||
| No specific recommendations for high triglyceride levels and low HDL cholesterol levels | Measure triglyceride and HDL cholesterol levels, with age- and sex-specific norms | ||
| Diet and exercise | |||
| Begin nutritional therapy at 2 yr of age | Begin nutritional therapy with reduced-fat milk at 1 yr for children at risk owing to obesity or family | ||
| Initiate treatment with NCEP Step-One Diet (total fat 20 to 30% of total calories consumed, saturated fat <10%, dietary cholesterol <300 mg/day); if diet is not effective after 3 mo, progress to Step-Two Diet: (total fat 20 to 30%, saturated fat <7%, dietary cholesterol <200 mg/day] | Follow Dietary Guidelines for Americans, with saturated fat <7%, trans fat <1%, dietary cholesterol <200 mg/day, and suggested fiber intake equal to child’s age plus 5 g/day, up to 20 g/day at 15 yr of age | ||
| Encourage regular exercise | Encourage physical activity for weight management and for treatment of high triglyceride levels and low HDL cholesterol levels | ||
| Pharmacology | |||
| Use bile acid-binding agents as first-line agent; stations not recommended | Include statins among potential first-line agents | ||
| 10-yr minimum age for pharmacotherapy | 8-yr minimum age for pharmacotherapy | ||
| Initiate pharmacotherapy for LDL cholesterol level of ≥190 mg per deciliter or ≥160 mg per deciliter with positive family history or 2 additional risks | Use new LDL cholesterol treatment cutoff point of ≥130 mg per deciliter if diabetes mellitus present | ||
Notes: Copyright © 2008. Massachusetts Medical Society. All rights reserved. Reprinted with permission from de Ferranti S, Ludwig DS. Storm over statins–the controversy surrounding pharmacologic treatment of children. N Engl J Med. 2008;359(13):1309–1312.30
Abbreviations: AAP, American Academy of Pediatrics; HDL, high-density lipoprotein; LDL, low-density lipoprotein; NCEP, National Cholesterol Education Program.