Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents

Abstract

Abstract-Despite compliance with lifestyle recommendations, some children and adolescents with high-risk hyperlipidemia will require lipid-lowering drug therapy, particularly those with familial hypercholesterolemia. The purpose of this statement is to examine new evidence on the association of lipid abnormalities with early atherosclerosis, discuss challenges with previous guidelines, and highlight results of clinical trials with statin therapy in children and adolescents with familial hypercholesterolemia or severe hypercholesterolemia. Recommendations are provided to guide decision-making with regard to patient selection, initiation, monitoring, and maintenance of drug therapy.

Consenso da Associação Brasileira de Nutrologia sobre manejo da dislipidemia secundária à obesidade infanto-juvenil

“…A American Heart Association e a American Academy of Pediatrics sugeriram modificação da idade de início do tratamento farmacológico da dislipidemia para 8 anos de idade 39,70 . No presente consenso, propõe-se que, após nova dosagem de perfil lipídico, a criança que permanecer com LDLcolesterol acima de 190 mg/dL ou com LDL-colesterol acima de 160 mg/dL com fator de risco (parentes de primeiro grau com DAC prematura, HDL-colesterol < 35 mg/dL, tabagismo, HAS ou diabetes mélito), deva ser submetida a tratamento farmacológico [71][72][73] .…”

Familial Hypercholesterolemia: A Decade of Progress

“…8 Effective treatment for elevated cholesterol, particularly for children, did not exist until the development of the statins, a class of drugs that inhibit cholesterol synthesis in hepatic cells (and elsewhere) and, in consequence, increase LDL receptor expression and thus lower serum cholesterol levels. 9 Clinical trials of 1 to 2 years duration have now been conducted in children for all the important statins leading to FDA approval for lovastatin, pravastatin, simvastatin, and atorvastatin use in childhood; all lower cholesterol safely for the duration of the trials. Trials of rosuvastatin, the most potent statin on a mg for mg basis, are nearing completion.…”

“…This experience has recently been reviewed in an American Heart Association scientific statement that provides guidelines for their use in those with elevated cholesterol. 9 Medications that inhibit bile acid or cholesterol absorption have also been used to lower LDL cholesterol; because they work by a different mechanism of action, they are synergistic with statins and can significantly increase LDL cholesterol reduction when used in combination. Cholestyramine, a resin that inhibits bile reabsorption, has been 4 used for decades though gastrointestinal side effects are common.…”

Lipodistrofia em crianças e adolescentes com síndrome da imunodeficiência adquirida e sua relação com a terapia antirretroviral empregada

“…7 From 20 to 50% of children with AIDS treated with HAART, including protease inhibitors, develop dyslipidemia(s), the most common of which is elevated total cholesterol and LDL. 8 In adults with HIV, dyslipidemia is associated with an increased risk of developing cardiovascular diseases.…”

“…However, it is worthy of note that treatment with statins, especially in high doses, in association with protease inhibitors, increases the risk of myositis/myolysis. 8 With relation to the lipodystrophy syndrome, studies indicate that the prevalence is 25 to 30% among the pediatric population with AIDS and that the mean time taken for abnormalities to appear after starting HAART is between 7 and 31 months. Clinical diagnosis of lipodystrophy, widely used in practice, underestimates the redistribution of body fat when compared with specific tests for the same purpose, such as dual-energy X-rays (DXA).…”