taking pillsFor children and adults with elevated levels of “bad” cholesterol, guidelines are available to point physicians to the most appropriate treatment. But for patients who are no longer children but not quite yet adults, knowing which recommendations to follow hasn’t been clear-cut.

Now, a new study has found that applying pediatric cholesterol guidelines to patients ages 17 to 21 with elevated LDL would result in cholesterol-lowering statin treatment for more than 400,000 additional young people than the adult guidelines. The research was published online Monday in JAMA Pediatrics.

Risk factors for heart disease such as abnormal cholesterol levels often emerge during adolescence. The recommendations for statin use differ between the cholesterol guidelines for children and adolescents from the National Heart, Lung, and Blood Institute and the adult guidelines from the American Heart Association and American College of Cardiology.

Because 17- to 21-year-olds are often transitioning from pediatric care to adult-centered care, these disparate approaches may lead to confusion in clinical practice, the study authors said.

Of the 6,338 people ages 17 to 21 who were included in the analysis, 2.5 percent would qualify for statin therapy under the pediatric guidelines compared with 0.4 percent under the adult guidelines. That means that of the 20.4 million Americans who are ages 17 to 21, 483,500 of them would be eligible for statin drugs under the pediatric guidelines compared with only 78,200 under the adult guidelines.

The actual number treated is likely to be much lower considering people in this age group are not routinely screened for high cholesterol, among other reasons, the authors noted.

The researchers concluded that given the uncertain knowledge and conflicting guidelines for treating elevated cholesterol in this age group, doctors and patients should come to a shared decision after discussing the potential harms and benefits and the patient’s preferences for treatment.

The authors also noted that “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.”