Lipid Guidelines Could Boost Youths' Statin Use

Applying pediatric lipid guidelines to adolescents might result in more than 400,000 additional young adults taking statins.

A new study published in JAMA Pediatrics analyzed survey results from 6338 individuals aged 17 to 21 years who participated in the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2012.

Applying the 2011 Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents of the National Heart, Lung, and Blood Institute and the 2013 Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults from the American College of Cardiology and American Heart Association to the NHANES population, the researchers set out to determine which participants would meet the guidelines’ criteria for the treatment of elevated low-density lipoprotein cholesterol (LDL-C) levels.

The researchers found 2.5% would qualify for statin treatment under pediatric guidelines, while only 0.4% would qualify under adult guidelines.

The results were then extrapolated to the 20.4 million individuals aged 17 to 21 years in the United States, which led the authors to estimate 483,500 youth would be eligible for statin treatment for LCL-C levels if the pediatric guidelines were used. In contrast, 78,200 youth would meet the same criteria if the adult guidelines were applied.

While there could be a significant jump in the amount of adolescents taking statins, the researchers surmised the number would be lower in reality.

“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,” the researchers noted.

The pediatric guidelines recommend screening for lipid levels in all individuals aged 17 to 21 years and then prescribing statins for those who have LDL-C levels of at least 190 mg/dL without other risk factors, or at least 130 or 160 mg/dL when other risk factors are present. Meanwhile, the adult guidelines recommend statin treatment for adolescents when LDL-C levels are at least 190 mg/dL.

These potential differences in statin prescribing could lead to confusion throughout the health care team, the researchers noted. Both approaches have also raised concerns about the overdiagnosis and overtreatment of patients without known cardiovascular disease (CVD).

Thus, the researchers advised clinicians and patients to make a shared decision about treatment that considers potential harms and benefits.

Study author Holly Gooding, MD, MSc, of the Division of Adolescent/Young Adult Medicine at Boston Children’s Hospital, told Pharmacy Times that this is where pharmacists can jump in to help adolescents combat CVD.

“For those who choose pharmacologic treatment for their elevated LDL-C levels, pharmacists can play a major role in assisting with medication adherence, which we know can be challenging for this age group,” Dr. Gooding said.

Dr. Gooding also told Pharmacy Times that pharmacists could promote adherence to healthy lifestyles among youth populations and provide help with tobacco cessation for young adults who smoke.

Both guidelines suggest patients would benefit from goals related to these modifiable risk factors.