A Systematic Review and Meta-Analysis of Statin Therapy in Children With Familial Hypercholesterolemia

Abstract

Objective-Functional and morphological changes of the arterial wall already present in young children with heterozygous familial hypercholesterolemia (HeFH) suggest that treatment should be initiated early in life to prevent premature atherosclerotic cardiovascular disease. The purpose of this study was to assess the efficacy and particularly safety of statin therapy in children with HeFH. Methods and Results-We performed a meta-analysis of randomized, double-blind, placebo-controlled trials evaluating statin therapy in children aged 8 to 18 years with HeFH. Six studies (nϭ798 children) with 12 to 104 weeks of treatment were included. Total cholesterol, LDL cholesterol, and apolipoprotein B were significantly reduced, whereas HDL cholesterol and apolipoprotein A1 were significantly increased by statin therapy. No statistically significant differences were found between statin-and placebo-treated children with respect to the occurrence of adverse events (RR 0.

Integrated guidance on the care of familial hypercholesterolaemia from the International FH Foundation

“…Early cholesterol-lowering treatment can substantially alter the natural history of FH [53,56,[108][109][110][111][112]145]. Although systematic reviews confirm the safety of currently employed statins in children [146,147], the long-term sequelae of high intensity statin regimens are unknown. Good longterm data on the safety of statins started early in life are therefore required [148,149], emphasizing the need to establish a suitable international registry [150].…”

“…Agents tested in clinical trials and approved for use by regulatory agencies should be used [8,19,20,22,65,66,73]; statin drugs are preferred and should be initiated at low doses [146,147]. Statin treatment with approved medications can be initiated at 8-10 years of age and not delayed until 18 years [8,19,20,22,65,66,73].…”

Statin treatment of children with familial hypercholesterolemia – Trying to balance incomplete evidence of long-term safety and clinical accountability: Are we approaching a consensus?

“…Это является основанием для интенсивного пожизненного лечения с детского возраста [25][26][27][28][29]. Очевидно, что лечение больных должно опираться на уровень липидов в плазме и общую оценку риска сердечно-сосудистых заболеваний, а не на резуль-таты генетического анализа.…”

“…Раннее начало холестеринсни-жающей терапии может существенно изменить есте-ственное течение заболевания, и систематические обзоры подтверждают безопасность применения одо-бренных статинов у детей [28,29]. Терапию одобрен-ными к применению статинами следует начинать в возрасте 8-10 лет и не откладывать до 18 лет.…”

Fasting Might Not Be Necessary Before Lipid Screening: A Nationally Representative Cross-sectional Study

“…The high prevalence of obesity, 1 the recognition that hyperlipidemia in childhood has an immediate impact and might have a long-term impact on cardiovascular physiology, [2][3][4] and the increasing number of treatment options for hyperlipidemia in children 5,6 have all led the American Academy of Pediatrics (AAP) and the American Heart Association to recommend fasting lipid panel screening for children as young as 2 years who are at risk for dyslipidemia. 6,7 Screening of children for lipid disorders presents unique challenges.…”