Treatment to lower cholesterol should begin in childhood in order to maximise its efficacy at preventing heart disease, specialists say.

They claim that despite the success of cholesterol-lowering treatments such as statins, which have cut adult deaths from heart disease by around 30 per cent, most patients are treated too late to gain maximum benefit. Writing in the journal Circulation, Professor Daniel Steinberg of the University of California and colleagues say doctors have been slow to measure cholesterol levels in children, still less to prescribe cholesterol-lowering regimes for them.

But in a review of research they say that lowering cholesterol in children and young adults could be potentially life-saving. While it should ideally be achieved through diet and exercise, drug treatment may also be necessary for those at the highest risk. "Our review of the literature convinces us that more aggressive and earlier intervention will probably prevent considerably more than 30 per cent of coronary heart disease," said Professor Steinberg.

"Studies show that fatty-streak lesions in the arteries that are a precursor to thickening and heart disease begin in childhood and advanced lesions are not uncommon by age 30. Why not nip things in the bud?"

Tests carried out on Japanese men in the 1950s showed that eating a low-fat diet from infancy resulted in lifelong low cholesterol levels. Their death rate from heart disease was one-tenth that found in the US, where fat intake is much higher.

Treatment for 50-year-olds is effective but is unlikely to reverse established heart disease and will therefore have a limited impact in terms of preventing heart attacks. The evidence is now overwhelming that low cholesterol equals low rates of heart disease, the group says.

"Our long-term goal should be to alter our lifestyles, beginning in infancy or early childhood. Instituting a low-fat, low-cholesterol diet at seven months is perfectly safe."

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