CHICAGO — Should all US children be tested for high cholesterol? Doctors are still debating that question months after a government-appointed panel recommended widespread screening that would lead to prescribing medicine for some kids.
Fresh criticism was published online Monday in the journal Pediatrics by researchers who say the guidelines are too aggressive and were influenced by panel members’ financial ties to drug makers.
Eight of the 14 panel members reported industry ties and disclosed that when their advice was published in December. They contend in a rebuttal article in Pediatrics that company payments covered costs of evaluating the drugs but did not influence the recommendations.
The ties pose a conflict of interest that ‘‘undermines the credibility of both the guidelines and the process through which they were produced,’’ says a commentary by researchers at the University of California San Francisco.
Other criticism was published earlier this year in the Journal of the American Medical Association. That critique raised concerns about putting children on cholesterol drugs called statins, noting the medicine has been linked with a rare muscle-damaging condition in adults.
JAMA included additional criticism from a dissenting member of the panel that produced the kids’ cholesterol guidelines, Dr. Matthew Gillman of Harvard Medical School. He recommends more narrow screening based on family history of cholesterol problems.
The guidelines are endorsed by the Academy of Pediatrics, which publishes the journal that carried the critical commentary Monday. The panel recommends that all US children get blood tests for high cholesterol as early as age 9 and that testing begin much earlier for kids at risk of heart disease, including those with diabetes or a family history of heart problems. Treatment should generally begin with lifestyle changes including diet and exercise, the guidelines say.
Drugs would be recommended for some kids, but probably less than 1 percent of those tested. But the advice says those drugs, including statins, should not be used at all in children younger than 10 unless they have severe problems.
The guidelines aim to help prevent and treat conditions in children that put them at risk for later heart-related problems. At least 10 percent of US children have unhealthy cholesterol levels and one-third are overweight or obese.
Dr. Sarah De Ferranti, an American Academy of Pediatrics spokeswoman and director of preventive cardiology at Boston Children’s Hospital, said the question should be part of a conversation parents should have with their pediatrician about heart disease risks, including weight, blood pressure, and lifestyle. She said she would have her children tested.
The critics say there’s little evidence that widespread testing and treatment will reduce children’s chances of having heart problems later. They argue that the testing is costly and could cause anxiety in healthy children.