Using pediatric cholesterol guidelines for teens, young adults would increase statin use
2015-04-06
(Press-News.org) Application of pediatric guidelines for lipid levels for persons 17 to 21 years of age who have elevated low-density lipoprotein cholesterol (LDL-C) levels would result in statin treatment for more than 400,000 additional young people than the adult guidelines, according to an article published online by JAMA Pediatrics.
Adolescence is a common time for the emergence of risk factors for cardiovascular disease, including abnormal cholesterol levels. The 2011 National Heart, Lung, and Blood Institute Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents and the 2013 American College of Cardiology and American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults differ in their recommendations regarding statin use. Because 17 to 21 years is a typical age for transition from pediatric to adult-centered care, these disparate approaches may lead to confusion in clinical practice, according to background information in the article.
Holly C. Gooding, M.D., M.Sc., of Boston Children's Hospital, and colleagues compared the proportion of young people 17 to 21 years of age who meet criteria for pharmacologic treatment of elevated LDL-C levels under pediatric vs adult guidelines. The researchers used data from the National Health and Nutrition Examination Survey (NHANES). Surveys were administered from January 1999 through December 2012, and the analysis was performed from June through December 2014.
Of the 6,338 persons 17 to 21 years of age in the NHANES population included in this analysis, 2.5 percent would qualify for statin treatment under the pediatric guidelines compared with 0.4 percent under the adult guidelines. Extrapolating to the U.S. population of 20.4 million people age 17 to 21 years, 483,500 individuals would be eligible for statin treatment under the pediatric guidelines compared with 78,200 under the adult guidelines, a difference of about 400,000. The authors note that the actual number treated is likely to be much lower owing to less than universal screening in this age group, challenges with adherence to medication regimens, and physician or patient disagreement with the recommendations.
Participants who met pediatric criteria had lower average LDL-C levels (167 vs 210 mg/dL) but higher proportions of other cardiovascular risk factors, including hypertension, smoking, and obesity compared with those who met 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 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," the researchers conclude.
INFORMATION:
(JAMA Pediatr. Published online April 6, 2015. doi:10.1001/jamapediatrics.2015.0168. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: Authors made conflict of interest disclosures. This work was supported through a Patient-Centered Outcomes Research Institute Assessment of Prevention, Diagnosis, and Treatment Options Program Award. Please see article for additional information, including other authors, author contributions and affiliations, etc.
Media Advisory: To contact corresponding author Holly C. Gooding, M.D., M.Sc., call Erin C. Tornatore at 617-919-3113 or email Erin.Tornatore@childrens.harvard.edu. An author audio interview will be available when the embargo lifts on the JAMA Pediatrics website: http://jama.md/1FZ6HWX
ELSE PRESS RELEASES FROM THIS DATE:
2015-04-06
Only a few U.S. nursing home residents who undergo lower extremity revascularization procedures are alive and ambulatory a year after surgery, according to UCSF researchers, and most patients still alive gained little, if any, function.
The study appears in the April 6 issue of JAMA Internal Medicine.
"Our findings can inform conversations among physicians, patients and families about the risks and expected outcomes of surgery and whether the surgery is likely to allow patients to achieve their treatment goals," said senior author Emily Finlayson, MD, MS, associate ...
2015-04-06
Seventy per cent of glacier ice in British Columbia and Alberta could disappear by the end of the 21st century, creating major problems for local ecosystems, power supplies, and water quality, according to a new study by University of British Columbia researchers.
The study found that while warming temperatures are threatening glaciers in Western Canada, not all glaciers are retreating at the same rate. The Rocky Mountains, in the drier interior, could lose up to 90 per cent of its glaciers. The wetter coastal mountains in northwestern B.C. are only expected to lose about ...
2015-04-06
DURHAM, N.C. -- Duke researchers have developed a new method to precisely control when genes are turned on and active.
The new technology allows researchers to turn on specific gene promoters and enhancers -- pieces of the genome that control gene activity -- by chemically manipulating proteins that package DNA. This web of biomolecules that supports and controls gene activity is known as the epigenome.
The researchers say having the ability to steer the epigenome will help them explore the roles that particular promoters and enhancers play in cell fate or the risk ...
2015-04-06
Stanford University scientists have invented the first high-performance aluminum battery that's fast-charging, long-lasting and inexpensive. Researchers say the new technology offers a safe alternative to many commercial batteries in wide use today.
"We have developed a rechargeable aluminum battery that may replace existing storage devices, such as alkaline batteries, which are bad for the environment, and lithium-ion batteries, which occasionally burst into flames," said Hongjie Dai, a professor of chemistry at Stanford. "Our new battery won't catch fire, even if you ...
2015-04-06
Most of today's anticancer drugs target the DNA or proteins in tumor cells, but a new discovery by University of California, Berkeley, scientists unveils a whole new set of potential targets: the RNA intermediaries between DNA and proteins.
This RNA, called messenger RNA, is a blueprint for making proteins. Messenger RNA is created in the nucleus and shuttled out into the cell cytoplasm to hook up with protein-making machinery, the ribosome. Most scientists have assumed that these mRNA molecules are, aside from their unique sequences, generic, with few distinguishing ...
2015-04-06
PROVIDENCE, R.I. - After analyzing stroke treatment records, researchers at Rhode Island Hospital in collaboration with researchers from the University of Cincinnati learned that women and men have different reasons for being excluded from receiving the common clot-dissolving drug, recombinant tissue plasminogen activator (rtPA). Importantly, more women had very high blood pressures, which reduced their eligibility to be treated with the highly effective drug. The study was recently published in the American Heart Association's (AHA) journal, Stroke.
"Although men and ...
2015-04-06
Women who believe smoking helps them manage their weight are less likely to try quitting in response to anti-smoking policies than other female smokers in the U.S.
The study, published online in the journal Tobacco Control, is the first to find that smokers who are concerned about their weight are less swayed by anti-smoking policies - such as bumps in cigarette prices, smoke-free laws or anti-tobacco messaging -- than other smokers are.
"We found that concerns about weight are a significant barrier to quitting," says lead author Ce Shang of the University of Illinois ...
2015-04-06
NEW YORK--A sad TV drama comes to conclusion, fading to black as music swells, and leaving the audience emotionally torn about the future of the main characters. Suddenly, the TV cuts to a peppy commercial and viewers are faced with the relentless cheer of an insurance spokesperson pitching their latest money saving product. This is a common occurrence in today's prime time-driven entertainment culture, but new research from Columbia Business School shows that this juxtaposition of emotions can leave TV viewers puzzled at the swing in content and emotion, so much so that ...
2015-04-06
AURORA, Colo. (April 6, 2015) - Brain activity affects the way the developing brain connects neurons and a study by researchers at the School of Medicine on the University of Colorado Anschutz Medical Campus and Children's Hospital Colorado suggests a new model for understanding that process.
In a study of zebrafish, scientists tested how brain activity affected the development of insulating sheaths on selected axons, which are slender nerve fibers that conduct electrical impulses between neurons. They found that, while the wrapping of axons was indiscriminate, the molecular ...
2015-04-06
Political parties find that their fortunes improve when they put more women on the ballot, according to a study co-authored by an MIT economist.
The study analyzes changes to municipal election laws in Spain, which a decade ago began requiring political parties to have women fill at least 40 percent of the slots on their electoral lists. With other factors being equal, the research found, parties that increased their share of female candidates by 10 percentage points more than their opponents enjoyed a 4.2 percentage-point gain at the ballot box, or an outright switch ...
LAST 30 PRESS RELEASES:
[Press-News.org] Using pediatric cholesterol guidelines for teens, young adults would increase statin use
