The market for a best-selling drug has just been extended to our kids.
The American Academy of Pediatrics now recommends cholesterol screening in children as young as two years if there are “weight issues” or if a child’s family has a history of heart attacks or elevated cholesterol. If a youngster’s cholesterol is high, treatment might include cholesterol-lowering drugs, called statins.
According to the AAP’s Nutrition Committee, “The risk of giving statins at a lower age is less than the benefit you’re going to get…”
Since 1987—when Merck’s lovastatin was first approved by the FDA—these medications have been hailed as the most effective way to reduce LDL cholesterol. Indeed, statins may lower LDL by as much as 40%, and this diminishes the patient’s risk of heart attack and stroke. The pharmaceutical industry has reaped some benefits, too: US sales of statins reached $20 billion last year.
While proponents of the new AAP recommendation extol the virtues and low side-effect profile of statins, there are some valid questions that the “experts” seem to be sidestepping (remember that five of the fourteen panel members—including the chairman—who originally recommended widespread use of statins declared financial relationships with the makers of these drugs). For example, not long ago, statins—more specifically, very low LDL levels—were implicated in an increased incidence of cancer. While this issue is still controversial, reevaluation of available data supposedly revealed that statin use is unrelated to cancer.
Unfortunately, when one examines the mechanism by which statins work, one discovers that these agents not only inhibit the production of LDL cholesterol; they also interfere with the manufacture of Coenzyme Q10 (CoQ10), a critically important molecule that is found in nearly every cell in the human body. CoQ10 resides in the membranes of tiny intracellular structures called mitochondria, and it is vital to any cellular process that involves the production or consumption of energy—which covers a lot of territory.
CoQ10 levels, like LDL cholesterol, can be suppressed as much as 40% in statin users. Any organ or tissue that has high energy requirements (brain, heart, nerve, muscle, kidney, and endocrine system) could be impaired if supplies of this molecule are inadequate. The potential ramifications of CoQ10 depletion are legion, but (at least in this country) this aspect of statin use doesn’t get much attention.
Among the purported and proven effects of decreased CoQ10 levels are:
- Suboptimal white blood cell activity (white cells are major components of our immune system, and they’re necessary to help protect us from infections and—notably—cancer).
- Reduced strength of muscle fiber contraction. While this may not be noticeable in the day-to-day function of skeletal muscle, cardiac muscle may suffer a more telling effect—statins have been implicated in the worsening of congestive heart failure in patients at risk. Interestingly, CoQ10 is commonly used in Japan for the treatment of heart disease.
- Impaired liver function. The liver is the main site for detoxification and metabolism of potentially harmful substances found in our environment, in our food, and in medications (like statins).
- Decreased cell growth and division. These are energy-intensive processes, and low levels of CoQ10 could conceivably interfere with normal cell growth.
- Decreased ability to clear free radicals. CoQ10 exerts an antioxidant influence at the cellular level by sparing glutathione and superoxide dismutase, thus protecting cells from cancer-promoting free radicals.
Clearly, the issue of cholesterol management is not as straightforward as some would have us believe. While the American Academy of Pediatrics has long championed the safety of this country’s children, the recommendation to prescribe statins in this population might merit another look.
Stephen Allen Christensen - Dr. Steve Christensen's writing has appeared in magazines, professional journals, poetry anthologies, and children's books since 1976.
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