Abstract
Recently there has been concern regarding the prevalence of medication use in children to manage the same cardiometabolic risk factors that traditionally begin in adulthood, but are now more prevalent in children. Two studies have been published reporting the actual prevalence of medication use in children to treat the conditions of high blood pressure, high cholesterol, and diabetes. Both studies report that the overall prevalence of medication use among children to manage these conditions is increasing. Concurrently, physical activity levels and healthy eating habits in children are decreasing and the incidence of obesity is increasing. Although medications used to treat cardiometabolic risks are important for preventing future cardiovascular disease, greater resources should be dedicated toward lifestyle medicine–related treatment and prevention efforts in this population to improve the future health of these individuals and the general health of America.
‘As with adults, medications to control high blood pressure, high cholesterol, and diabetes are preventive by nature for children because they decrease the risk for future cardiovascular diseases.’
The use of medications in adults with risk factors for cardiovascular disease has increased over the past few decades. 1 This is partly due to better identification of diseases, greater drug efficacy, and better patient compliance. Recently, however, there has been concern regarding the prevalence of medication use in children to manage the same cardiometabolic risk factors that traditionally begin in adulthood, but are now more prevalent in children. As with adults, medications to control high blood pressure, high cholesterol, and diabetes are preventive by nature for children because they decrease the risk for future cardiovascular diseases. However, if the prevalence of medication usage in children for the purposes of reducing cardiovascular disease risk in increasing, what is this telling us about the progression of the health status in America and about the “true causes” for the increased prevalence?
Two studies have been published looking at the trends and prevalence of medication use in children.2,3 Both studies used a similar observation period, 2002 to 2005 and 2004 to 2007. During this time, the prevalence of the cardiometabolic risk factors of diabetes, high blood pressure, and high cholesterol in children were as follows: type 2 diabetes (0.15% to 0.22%), hypertension (2.2% and 13.8%), and high total cholesterol (4.0%). 3
The first of these studies was published in the journal Pediatrics in 2008 and looked at the trends and prevalence of chronic medication use in more than 3 million children in the United States between 2002 and 2005. 2 This study specifically looked at medication use in children who were insured and between the ages of 5 and 19 years. The medications reviewed were those used to treat the conditions of hypertension, hyperlipidemia, type 2 diabetes, depression, attention deficit disorder, attention deficit hyperactivity disorder, and asthma. 2
Overall, the prevalence of chronic medication use among children between the ages of 5 and 19 years increased between 2002 and 2005. 2 Specifically, those conditions considered to be cardiometabolic risk factors (ie, hypertension, hyperlipidemia, and type 2 diabetes) showed a greater prevalence of usage as the age of children increased. Children aged 15 to 19 years were at least 2 times more likely than children aged 10 to 14 years and 3 times more likely than children aged 5 to 9 years to take medications for cardiometabolic risk reduction. 2
Looking specifically at individual diseases, type 2 diabetes medication usage showed an overall increase of 103% between 2002 and 2005. 2 This was largely due to a 166% increase in drug use among 10- to 14-year-old girls and a 135% increase in drug use among 15- to 19-year-old girls. Overall, the prevalence in girls increased 146% versus 39% in boys. The authors note that this increased prevalence may be due to the increased prevalence in obesity among children. However, the difference in prevalence rates between girls and boys may also be partially explained by the increased usage of the type 2 diabetes medication, metformin, to treat polycystic ovary syndrome, overweight, and/or metabolic syndrome. Additionally, the older aged girls may be making more frequent physician office visits compared with boys of the same age. 2
The prevalence of antihypertensive medication usage showed an overall increase of 2% across the observation period for all age groups. 2 Unlike the gender differences observed in type 2 diabetes drug usage, boys demonstrated a higher prevalence of usage compared to girls (6% vs −2%, respectively). The highest rate of increase was observed in boys aged 15 to 19 years, which showed a 15% increase from 2002 to 2005. 2
Antihyperlipidemic drug usage increased by 15% overall between 2002 and 2005. 2 The largest rate increase (24%) was observed among girls aged 15 to 19 years. No significant differences were observed between boys and girls with regard to medication use to control cholesterol. Both genders observed a 14% to 15% growth increase. 2
The second study looking at medication usage in children was published in 2009 in the Archives of Pediatrics and Adolescent Medicine. 3 The objective of this study was to describe the prevalence and current trends in antihypertensive, antidiabetic, and dyslipidemia medication use among US children aged 6 to 18 years. The observation period was from 2004 to 2007 and included nearly 6 million individuals. The authors note that their study population represented nearly 11% of the projected US population in the age groups that were studied. 3
The results of this study showed an increase of 15.2% in the overall usage of medications to control hypertension, dyslipidemia, and diabetes. 3 The greatest rate increase was observed in children 6 to 11 years old. Girls in this age group increased medication usage for these conditions by 18.7% and boys by 17.3%. 3
This study showed dyslipidemia medication use among children to be uncommon. 3 Dyslipidemia treatment prevalence did not increase during this time period, but rather decreased by 14% to 20% in all groups. The one exception to this was observed in 16- to 18-year-old girls, who demonstrated a 14% increase in dyslipidemia medication use during this time period. Statin usage to control dyslipidemia was the most commonly preferred treatment in this study, representing 63% of all pharmacotherapy. Over the observation period, however, statin use decreased while other dyslipidemia medications increased. The authors note that treatment controversy on the use of statins in the pediatric population published during the study period most likely contributed to the decreased statin use and to the overall decrease in dyslipidemia medication usage in children from 2004 to 2007. 3
The use of oral antidiabetic medications increased by 23.3% overall during the observation period, while antihypertensive medication usage increased by 15.3%. 3 The most dramatic rate of increase for antihypertensive medication use occurred between the ages of 6 and 11 years. Both boys and girls experienced prevalence rates that increased more than 20%. 3
The authors of the second study point out that increases in treatment prevalence in the pediatric population, especially at the younger ages, may be due to an increased awareness of existing hypertension and diabetes among children rather than an overall increase in the incidence of hypertension and/or diabetes. 3 However, it is well documented that increases in overweight and obesity among children are occurring at the same time that the prevalence of primary hypertension and diabetes are increasing.3-5 Interestingly, however, a meta-analysis published in 2007 in the journal Pediatrics concluded that the worldwide epidemic of overweight children has not resulted in an increase in blood pressure levels among children. 6
Regardless of the correlations that have been observed or not observed, it is well known that obesity in children continues to increase and the participation in lifestyle medicine activities continues to decrease. The Centers for Disease Control and Prevention (CDC) reports that physical activity declines as children get older. 7 Only 18% of females and 38% of males in high school achieve the recommended amounts of physical activity each day. 7 Additionally, only 27% of females and 35% of males in high school attend daily physical education class. 7 Equally as disturbing, the CDC also reports that most children in the United States do not eat the recommended amounts of fruits, vegetables, and whole grains and exceed the recommended amount of sodium intake. 8
Conclusions
The overall prevalence of medication usage in children to treat conditions such as high blood pressure, high cholesterol, and diabetes is rising. The use of these medications in children is necessary and important to prevent further cardiometabolic complications in the future. However, greater resources should be dedicated toward lifestyle medicine–related treatment and prevention efforts in this population to improve the future health of these individuals and the general health of America.