Evidence-Based Diabetes Management May 2015
More Young Adults Would Take Statins Under Pediatric Guidelines, Study Finds
When treating a person aged 17 to 21 years, which clinical guidelines should apply? Should physicians follow pediatric guidelines, or those for adults? Would it make a difference?
In the case of statins, 400,000 more young people in this age group might be taking them for elevated levels of low-density lipoprotein (LDL) cholesterol if physicians followed pediatric guidelines, according to a study published April 6, 2015, in JAMA Pediatrics.
Researchers led by Holly C. Gooding, MD, MSc, performed a cross-sectional analysis of the National Health and Nu-trition Examination Survey (NHANES) population from 1999-2012, capturing 6338 participants in the United States aged 17 to 21 years. Using an algorithm from the National Heart, Lung, and Blood Institute and applying the 2013 guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA), the researchers extrapolated their results across the 20.4 million young adults in the age group.
The authors noted that cardiovascular risk can emerge in late adolescence, just as young people leave behind their pediatrician and find a new primary care doctor. The authors also discussed the uproar that followed the release of the 2013 ACC/AHA guidelines, which some felt would overtreat cardiovascular disease, as well as the confusion of reconciling the pediatric and adult guidelines.
Until this study, they wrote, no one had reported on the discrepancies between pediatric and adult guidelines that must be considered when treating adolescents transitioning to young adulthood.
Of the study group participants, 2.5% would qualify for statin treatment un-der the pediatric guidelines, compared with only 0.4% under the adult guide-lines. Those who met the pediatric guidelines had a lower mean LDL cholesterol level (167.3 vs 210.0 mg/dL), but a higher proportion of their group had other cardiovascular risk factors such as smoking, hypertension, and obesity, than those who met the adult guidelines. This translates into 483,500 of the population in the 17-to-21-year age group who would take statins un-der pediatric guidelines, compared with 78,200 under the adult guidelines.
“Given the current uncertain state of knowledge and conflicting guidelines for treatment of lipid levels among youth aged 17 to 21 years, physicians and pa-tients should engage in shared decision making around the potential ben-efits, harms, and patient preferences for treatment,” the researchers concluded.
“The 2013 American College of Cardi-ology and American Heart Association guidelines recommend shared decision making with patients for whom data are inadequate, including young people with a high lifetime risk for atheroscle-rotic cardiovascular disease. 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.”
Gooding HC, Rodday AM, Wong JB, et al. JAMA Pediatr [published online April 6, 2015]. doi.10.1001/jamapediatrics.2015.0168.