400K more young adults qualify for statins under pediatric guideline

More than 400,000 adolescents would be eligible to receive statins if providers adopted pediatric guidelines instead of adult guidelines, according to a cross-sectional analysis.

Lead researcher Holly C. Gooding, MD, of Boston Children’s Hospital in Massachusetts, and colleagues published their findings online in JAMA Pediatrics on April 6.

They examined the National Health and Nutrition Examination Survey, which was administered from Jan. 1, 1999 through Dec.  31, 2012. They then applied treatment algorithms from 2011 from the National Heart, Lung, and Blood Institute (NHLBI) for children and young adults and from 2013 from American College of Cardiology (ACC) and American Heart Association (AHA) for adults.

The NHLBI guidelines recommended lipid screening for anyone from 17 to 21 years of age and treatment with statins for young adults with low-density lipoprotein cholesterol (LDL-C) levels of at least 190 mg/dL without other risk factors or at least 130 or 160 mg/dL if they had other risk factors.

Meanwhile, the ACC/AHA guidelines recommended medication for people younger than 40 years of age only if their LDL-C level is at least 190 mg/dL.

This analysis, which was performed from June through December 2014, included 6,338 people between 17 to 21 years of age.

Researchers estimated 2.5 percent and 0.4 percent of adolescents would be treated if the NHLBI and ACC/AHA guidelines were fully applied, respectively. They found that young adults who met the NHLBI guidelines had lower mean total cholesterol and LDL-C levels and higher triglyceride levels. They also had higher proportions of cardiovascular risk factors such as hypertension, smoking and obesity.

If the NHLBI guidelines were fully applied, 483,500 people from 17 to 21 years of age would be eligible for statin treatment compared with 78,200 people of the same age range if the ACC/AHA guidelines were fully applied.

“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 wrote.