Correlates of Achieving Statin Therapy Goals in Children and Adolescents with Dyslipidemia

Abstract

Objective To determine the real world effectiveness of statins and impact of baseline factors on low-density lipoprotein cholesterol (LDL-C) reduction among children and adolescents. Study design We analyzed data prospectively collected from a quality improvement initiative in the Boston Children’s Hospital Preventive Cardiology Program. We included patients ≤ 21 years of age initiated on statins between September 2010 and March 2014. The primary outcome was first achieving goal LDL-C, defined as <130 mg/dL, or <100 mg/dL with high-level risk factors (e.g. diabetes, etc.). Cox proportional hazards models assessed the impact of baseline clinical and lifestyle factors. Results Among the 1521 pediatric patients evaluated in 3813 clinical encounters over 3.5 years, 97 patients (6.3%) were started on statin therapy and had follow-up data (median age 14 [IQR 7] years), 54% were female, 24% obese, 62% with at least one lifestyle risk factor. The median baseline LDL-C was 215 (IQR 78) mg/dL and median follow-up after starting statin was 1.0 (IQR 1.3) year. The cumulative probability of achieving LDL-C goal within 1 year was 60% (95% CI 47, 69). Male sex (HR 0.5 [95% CI 0.3, 0.8]) and higher baseline LDL-C (HR 0.92 [95% CI 0.87, 0.98] per 10 mg/dL) were associated with not achieving LDL-C goals, but not age, BMI percentile, lifestyle factors or family history. Conclusions The majority of pediatric patients started on statins reached LDL-C treatment goals within 1 year. Males and those with higher baseline LDL-C were less likely to be successful and may require increased support.

Experience on statin therapy in paediatric age: retrospective study in a Portuguese referral centre

“…The data, in spite of being in line with the results of other studies, 19,24 support that the priority should be given to lifestyles modification, in association with pharmacological therapy. Indeed, the correct identification and stratification of children at risk for cardiovascular disease, coupled with increased educational initiatives, followed by the implementation of healthy living habits and early lipid-lowering therapies, will enable a more effective action in reducing the respective cardiovascular risk.…”

“…These values are in line with the results of some clinical trials where the percentage of reduction varies between 18.0 and 38.0% and between 23.0 and 49.0% for total cholesterol and low-density lipoprotein cholesterol, respectively. 10,15,19,37 Besides, the mean increase in high-density lipoprotein cholesterol (11.2 ± 20.6%) was quite significant when compared to the results obtained by other studies using the same types of statins (3.0-6.0%). 10,15,19 A decrease in triglycerides levels (8.3 ± 59.4%) was observed, albeit not statistically significant.…”

“…10,15,19,37 Besides, the mean increase in high-density lipoprotein cholesterol (11.2 ± 20.6%) was quite significant when compared to the results obtained by other studies using the same types of statins (3.0-6.0%). 10,15,19 A decrease in triglycerides levels (8.3 ± 59.4%) was observed, albeit not statistically significant. In fact, this is corroborated by other studies where the reductions found are modest and non-linear, or conversely, increases have been reported.…”

“…In fact, this is corroborated by other studies where the reductions found are modest and non-linear, or conversely, increases have been reported. 10,15,19,37 A decrease on atherogenic risk biomarkers was also observed, 4,10 namely apolipoprotein B/apolipoprotein A1 ratio and lipoprotein (a), with only the first parameter having a reduction with statistical significance.…”

“…In our study, lower rates of lipid control were observed as compared to a similar American study, which reported for similar treatment period, control of approximately 85% of patients. 19 However, comparingly, we defined more stringent low-density lipoprotein cholesterol target values and had a higher prevalence of Despite the decrease in serum fasting glucose levels, homeostasis model assessment-insulin resistance (HOMA-IR) index increased, non-significantly, during the follow-up period. This is in line with the increase in BMI present.…”