Secondary Dyslipidemia In Obese Children - Is There Evidence For Pharmacological Treatment?

Abstract

BackgroundLong-term safety, effectiveness and criteria for treatment with statins in children are still unclear in clinical practice. There is very limited evidence for the use of medication to treat children with dyslipidemia secondary to obesity who do not respond well to lifestyle modification.ObjectiveSystematic review of randomized clinical trials of statin use to treat children and adolescents with dyslipidemia secondary to obesity.MethodsWe performed a search in PubMed, EMBASE, Bireme, Web of Science, Cochrane Library, SciELO, and LILACS for data to evaluate the effect of statins on: improvement of surrogate markers of coronary artery disease in clinical outcomes of adulthood; increased serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and apolipropotein B (APOB); and decreased serum levels of high-density lipoprotein cholesterol (HDL-C) from inception to February 2016. Participants were children and adolescents.ResultsOf the 16793 potentially relevant citations recovered from the electronic databases, no randomized clinical trials fulfilled the inclusion criteria for children with dyslipidemia secondary to obesity.ConclusionsWe found no specific evidence to consider statins in the treatment of hypercholesterolemia secondary to obesity in children. The usual practice of extrapolating findings from studies in genetic dyslipidemia ignores the differences in long-term cardiovascular risks and the long-term drug treatment risks, when compared to recommendation of lifestyle changes. Randomized clinical trials are needed to understand drug treatment in dyslipidemia secondary to obesity.

Overview of Dyslipidemia in Childhood and Adolescence: Why Does It Matter and What Do We Do About It?

“…12 This is evident most markedly in HDL-C and triglycerides, with children who are obese having a 2-to 6-fold higher odds ratio of abnormal lipids than children with normal weight. 10,12,13 Excessive intake of saturated fat and trans fat also contributes to obesity and risk for abnormal lipid levels. 3 Children with inappropriate body fat percentage and weight-to-height ratio are more likely to have higher LDL-C and non-HDL-C than their counterparts with normal weight.…”

“…2 For nonfasting screens, the highest falsepositive rate is in triglycerides and the highest false-negative rate is in LDL-C. 2 If cholesterol levels are elevated with a nonfasting lipid panel, further evaluation should be completed with two separate fasting lipid panels at least 2 weeks apart. 3,13 Once the diagnosis of dyslipidemia has been made, other laboratory tests may be helpful in determining the cause, including serum alanine aminotransferase, serum albumin, blood glucose, renal function, and thyroid levels. 3…”

“…1,14 When children are young, their parents have a strong influence over their eating and exercise habits and should be encouraged to set a good example of how to lead a healthy lifestyle. 1,11,13 There are many choices that can significantly lower risk of abnormal lipids. Some of these include a diet that consists of fruits, vegetables, whole grains, fat-free or low-fat dairy products, and proteins such as meat, poultry, fish, beans, eggs, and nuts.…”

“…14 The initial approach to treatment of dyslipidemia is focused on a hearthealthy lifestyle with dietary modifications, increased physical activity, weight loss for children who are obese, and avoidance of nicotine. 4,13,18 To be successful, these modifications should be taken on by the entire family, not just the affected child. 10 Dietary measures include reduced intake of saturated fat, cholesterol, and trans fat, increased intake of dietary fiber, and a diet with a lot of fresh fruits, vegetables, and whole grains and high in polyunsaturated and monounsaturated fats.…”

“…4 The longest duration of follow-up studies in children taking statins at this point is only 2 years, so more information in the future will help determine how helpful statin treatment in children is long-term. 10,13 Baseline laboratory results should be obtained before starting a statin, including a fasting lipid profile, serum creatinine kinase, serum alanine aminotransferase, blood glucose, hemoglobin (Hgb) A1c, and a pregnancy test in girls. 4 Repeat testing should be done 8 weeks after the start of therapy.…”