The Effect of Long-Term Atorvastatin Therapy on Carotid Intima-Media Thickness of Children With Dyslipidemia

Abstract

Carotid intima-media thickness (cIMT) has been proposed as an early marker of subclinical atherosclerosis in high risk children. Children with heterozygous familial hypercholesterolemia have greater cIMT than matched healthy controls or their unaffected siblings. Statin therapy may delay the progression of cIMT, although long-term studies in children are scarce. We evaluated the effect of atorvastatin treatment on cIMT in children with dyslipidemia. We studied 81 children/adolescents, 27 with severe dyslipidemia (low-density lipoprotein cholesterol [LDL-C] ≥190 mg/dL) and 54 sex- and age-matched healthy controls; LDL-C ≤ 130 mg/dL and lipoprotein (a), Lp(a), ≤30 mg/dL. In the children with dyslipidemia, cIMT was measured twice, before and on treatment (18.2 ± 7.7 months). Anthropometric data, a full lipid profile, liver, kidney, and thyroid function were evaluated. Males with dyslipidemia had a greater cIMT than male controls after adjustment for other factors ( P = .049). In addition, a nonstatistically significant decrease in cIMT was observed after treatment ( P = .261). Treatment with atorvastatin resulted in a significantly improved lipid profile. Females with dyslipidemia had a significantly thinner cIMT than males. Children with normal and high Lp(a) levels had similar cIMT values. In conclusion, treatment with atorvastatin had a beneficial effect on the lipid profile and cIMT progression in children with severe dyslipidemia.

Screening for Lipid Disorders in Children and Adolescents

“…Limited longer-term evidence shows few withdrawals due to adverse events, slightly higher rates of liver and musculoskeletal laboratory elevations, and no significant differences in Tanner staging or hormonal adverse events between statin and placebo groups. These safety and efficacy findings are consistent with those from another recent systematic review and from 1- to 20-year observational follow-up studies of children and adolescents taking statins . Additional observational long-term reporting of health outcomes and statin safety (including diabetes, transaminitis) in those with FH for whom statins were initiated at various time points in childhood and adolescence would provide additional data for long-term benefits and harms.…”

A Case of Infantile Alagille Syndrome With Severe Dyslipidemia: New Insight into Lipid Metabolism and Therapeutics

“…IDL (remnant VLDL) is also captured by the apoprotein B receptor and LDL receptor in the liver. Therapeutic uses of atorvastatin in infants have not been reported in the literature, although the efficacy and safety of atorvastatin treatment in adolescents and children with familial hypercholesterolemia have been reported [ 6 ]. Its safety and efficacy in infants with AGS should be verified in future clinical studies.…”

“…Atorvastatin is a well-known and strong 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase inhibitor. In recent years, the clinical use of atorvastatin in children with hypercholesterolemia has shown excellent outcomes [ 6-8 ]. However, clinical trials of atorvastatin in infant and early-childhood cases of hyperlipidemia have rarely been reported.…”

Cardiovascular Risk Factors and Subclinical Atherosclerosis in Greek Adolescents with Polycystic Ovary Syndrome: Its Relationship with Body Mass Index

“…In all participants, subclinical atherosclerosis was evaluated by measuring the intima–media thickness (IMT) of the right and left common carotid artery (cIMT) in mm by an expert radiologist using a B-mode ultrasound. The method used has been described in a previous study by our group [ 17 ]. The cIMT values were compared with those of age-matched healthy adolescents without PCOS, and their association with anthropometric, biochemical, and hormonal markers was evaluated.…”