Statins in Children, an Update

Abstract

Since lipid abnormalities tend to progress from childhood to adulthood, it is necessary to early identify and treat children and adolescents with dyslipidemia. This is important in order to reduce the cardiovascular risk, delay the development of fatty streaks, slow the progression of atherosclerosis and reverse atherosclerotic plaques. Together with therapeutic lifestyle changes, statins are the most common lipid-lowering drugs. By inhibiting the endogenous cholesterol synthesis in the liver, statins increase the catabolism of LDL-C, reduce VLDL-C, IDL-C and TG and modestly increase HDL-C. Regardless of their lipid-lowering effect, statins have also pleiotropic effects. Statins have increasingly been prescribed in children and adolescents and mounting evidence suggests their beneficial role. As with adults, in children, several studies have demonstrated that statin therapy is efficient at lowering lipid levels and reducing CIMT progression and cumulative estimated atherosclerotic burden in children. Statins are generally very well-tolerated in both adults and children and adverse events are quite uncommon. When evaluating the need and the timing for statin treatment, the presence of several factors (secondary causes, familial history, additional risk factors) should also be considered. Before initiating statins, it is imperative for clinical practitioners to consult patients and families and, as with any new medication therapy, to monitor patients taking statins. Despite being safe and effective, many children with lipid disorders are not on statin therapy and are not receiving the full potential benefit of adequate lipid-lowering therapies. It is therefore important that clinicians become familiar with statins.

Management of Statin Intolerant Patients in the Era of Novel Lipid Lowering Therapies: A Critical Approach in Clinical Practice

“…If adverse events occur, they are nonserious and reversible events and principally include the liver toxicity, SAMS, teratogenic effects and drug-to-drug interaction. Despite the reported safety and efficacy, many children with lipid disorders are not on statin therapy; in this context, it is extremely important to early identify and manage children with lipid abnormalities in order to prevent their future cardiovascular risk [ 17 ].…”

Hyperlipidemia and Cardiovascular Risk in Children and Adolescents

“…Currently, seven commercially available statins have been approved for children and adolescents. Rosuvastatin is approved for use in children from the age of 7 years, pravastatin and pitavastatin are useful in patients with 8 years or older, while simvastatin, atorvastatin, lovastatin and fluvastatin may be used in patients from the age of 10 years [ 145 ]. Notably, pravastatin, simvastatin, and lovastatin are natural compounds, while fluvastatin, rosuvastatin, pitavastatin, and atorvastatin are synthetic products with linked fluorophenyl groups and larger hydrophobic regions [ 146 ].…”

“…Statins are approved by the Food and Drug Administration (FDA) for both heterozygous and homozygous FH [ 127 , 145 ]. In heterozygous forms not well controlled by physical activity and good dietary habits, statins may be useful for maintaining low LDL-C blood levels and reducing the risk of ASCVD.…”

“…In heterozygous forms not well controlled by physical activity and good dietary habits, statins may be useful for maintaining low LDL-C blood levels and reducing the risk of ASCVD. Indeed, LDL-C values in moderate-risk children, mainly represented by heterozygous FH, should be maintained at <130 mg/dL [ 145 , 149 , 150 ]. In high-risk patients, represented by homozygous FH, LDL-C values should remain < 100 mg/dL or be reduced by 50% from baseline values [ 145 , 149 , 150 ].…”

Novel Molecules in Diabetes Mellitus, Dyslipidemia and Cardiovascular Disease

“…Fiorentino et al analysed the benefits of statin use in children, a population where this medication is rarely used, and demonstrated numerous benefits such as a reduction in the atherosclerosis burden, with fewer side effects than in adults because of the presence of a very low number of comorbidities [ 7 ].…”