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April 2, 2004

Other Illnesses, Other Medications

Question from Millwood, Virginia, USA:

Our diabetes clinic has just asked us to begin giving our daughter Lipitor, 10 mg daily, with blood tests scheduled in six weeks to recheck the cholesterol, as well as hepatic chemistry. I want her cholesterol lowered and under control as it is now 207. However, I am concerned with long term affects of this drug. Will she have to stay on a drug like this? My plan is to get her numbers right, then get off the drug as soon as possible! My diabetic team does not listen to me when I tell them, repeatedly, that we have stringently watched our whole family diet for years. So, if there is NOT a dietary reason for high cholesterol, what causes the liver to overproduce cholesterol and are there any safe ways to lower the LDL? We eat high fiber, always, skim milk, very little cheeses, use a fair amount of soy, have been vegetarian for 5 years, though now we eat salmon once a week, lots of veggies, always whole grain options. I don't bake anymore and we exercise a lot. My daughter is tall, slim and active.


Actually, even under the best of optimal dietary approaches to limit cholesterol intake and with increased exercise, one can “only” lower the cholesterol by 10-20 percent. In some individuals, that is all it takes. The majority of cases of hypercholesterolemia is actually a genetic predisposition whereby the liver actually manufactures increased cholesterol. But, you have not given some important information: what was the “lipid profile?” Remember there is so-called “good cholesterol, ” which is denoted as HDL cholesterol, and so-called “bad cholesterol, ” which is denoted as LDL cholesterol. LDL cholesterol is bad for blood vessels and is involved with clogging of the arteries. On the other hand, HDL cholesterol is heart healthy! So, if the total cholesterol is elevated but it is predominantly HDL, then perhaps no intervention is required.

Lipitor and similarly related chemical compounds are referred to as “statins” and they decrease the total and LDL cholesterol levels by inhibiting the liver’s ability to manufacture cholesterol. These typically are NOT agents that you use for a brief time to get levels under control and them stop them. After you stop, the cholesterol levels typically will rise again.

Long term use of statins IN CHILDREN is not well studied. The short term side effect profile is similar to that seen in adults and, thus, liver functions are typically monitored periodically. The use of statins must be used cautiously with another family of fat lowering drugs called “fibrates.” Women of child bearing years are urged to not take statins when trying to conceive or when pregnant as these drugs may lead to serious birth defects. Careful contraception is urged.

I presume that your daughter’s diabetes team has excluded other causes of hypercholesterolemia that otherwise can be treated, including poorly controlled diabetes or hypothyroidism. Finally, because most hypercholesterolemia has a genetic propensity, the child’s parents likely should have their own lipid profiles assessed.