Authors say until now, no one has reported on the discrepancies that arise when applying pediatric vs adult guidelines on young people transitioning to adulthood.
When treating a young person age 17 to 21, which clinical guidelines 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 might be taking them for elevated levels of low-density lipoprotein (LDL) cholesterol if physicians followed pediatric guidelines for this age group, according to a study published today by JAMA Pediatrics.
Researchers led by Holly C. Gooding, MD, MSc, performed a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) population from 1999-2012, capturing 6338 participants ages 17-21 in the United States. 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 an new primary care doctor. The authors also discussed the uproar with the 2013 ACC/AHA guidelines, which some felt would overtreat cardiovascular disease, as well as the confusion of reconcilng the pediatric and adult guidelines.
Until this study, they write, no one has reported on the discrepancies that arise when applying pediatric vs adult guidelines to adolescents transitioning to young adulthood.
Of the study group, 2.5% would qualify for statin treatment under the pediatric guidelines, compared with only 0.4% under the adult guidelines. Those who met the pediatric guidelines had lower mean LDL cholesterol levels (167.3 vs 210.0 mg/dL) but higher proportions of other cardiovascular risk factors, including smoking, hypertension, and obesity, than those who met the adult guidelines. This translates into 483,500 of the US population in the 17-21 age group who would take statins under 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 patients should engage in shared decision making around the potential benefits, harms, and patient preferences for treatment,” the researchers conclude.
“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 a high lifetime risk for atherosclerotic 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.